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Glaucoma Procedures

Glaucoma is a leading cause of blindness in the United States, especially for older people. Fortunately, loss of sight from glaucoma is preventable if diagnosis and treatment occur early.

Glaucoma is a disease of the optic nerve. The optic nerve can be thought of as a cable containing around one million wires that carry images from the retina of the eye to the brain. As the optic nerve becomes damaged, these wires are destroyed over time, resulting in the development of blind spots. Damage from glaucoma usually develops slowly, and most people aren’t aware of these blind spots until they become severe and a large amount of permanent optic nerve damage has occurred. Although glaucoma can exist without elevated pressure inside of the eye, the higher the pressure, the greater chance of damage to the optic nerve. The progression of glaucoma can be slowed, and in most cases halted, by lowering the intraocular pressure adequately.

Early detection with a comprehensive eye exam and early initiation of treatment by your ophthalmologist are the keys to preventing optic nerve damage and blindness from glaucoma. Our physicians at The Eye Care Group employ state of the art diagnostic equipment, such as computerized perimetry (also known as visual field testing), nerve fiber analysis utilizing OCT and GDx technology, and stereophotography to help diagnose and monitor glaucoma. Treatment options are geared toward preventing further optic nerve damage and consist of eyedrop medications, noninvasive office laser treatments, and surgical operations. Please visit our Patient Education page to learn more about glaucoma.

LASER PROCEDURES
Most glaucoma laser procedures involve increasing flow through the openings of the natural internal drainage channels of the eye (the trabecular meshwork, or “TM” for short) to increase drainage of the eye’s nourishing fluid, the aqueous humour. The TM is located at the junction of the cornea and iris in what is referred to as the “angle” of the eye.

Trabeculoplasty: argon, diode, selective (abbreviated ALT, DLT, SLT): Application of laser light to the TM to increase outflow of aqueous humour, thereby lowering eye pressure.

Iridotomy: a pinhole size opening made through the iris in eyes with narrow angles or closed angles to preserve or reestablish access of the aqueous humour to the TM.

Iridoplasty: laser is used to contract the surface of the iris and pull it away from the TM in special cases of narrow angles, such as plateau iris, that may not fully respond to iridotomy.

Diode cyclophotocoagulation: a laser probe is placed on the surface of the eye that has been numbed. The laser energy penetrates to the underlying glands of the eye that make the aqueous, called the ciliary body, to reduce fluid production and lower pressure.

SURGICAL PROCEDURES
Our surgery coordinators meet with all pre-surgical patients to provide information and make all pre-operative arrangements. Most surgical glaucoma procedures are performed in an operating room at a nearby outpatient surgical center and generally take under an hour. When necessary, a glaucoma procedure is combined with other eye procedures such as cataract, corneal, or vitreoretinal surgery. The patient is sedated well during the surgery and goes home following the surgery, usually with a patch over the eye that is left on until examined in the office the following day. Follow-up exams are performed in the office.

Trabeculectomy: A new drainage tunnel is fashioned through the natural tissues of the wall of the eye. A small pocket of fluid forms between outer layers of the eye which in turn absorb the fluid, thereby lowering the eye’s pressure. A medication, such as mitomycin-C or 5-fluorouracil, is usually applied to the site during the surgery to reduce scar tissue formation.

Glaucoma shunt procedure: Also called a glaucoma drainage device, a small, plastic tube is inserted into the front or back of the eye and continually conducts fluid out of the eye to a plate, sometimes called a reservoir, to which it is connected. This reservoir is tucked beneath the outer tissues of the eye and forms a pocket of fluid which is absorbed by the surrounding tissue. The most commonly used glaucoma shunt devices include the Ahmed, Baerveldt, and Molteno.

ExPress minishunt: Similar to a trabeculectomy, a tiny metallic tube is placed in the tunnel to limit outflow.

Endocyclophotocoagulation (ECP): Often performed at the time of cataract surgery, a laser probe is inserted into the eye to treat the fluid-producing glands and reduce their production of fluid to lower pressure.

Trabectome: Often performed at the time of cataract surgery, a portion of obstructed drainage channels is stripped away to increase outflow of fluid.

Canaloplasty: The main outflow canal of the eye is widened and a small suture, or thread is used as a stent to keep it open for improved drainage.

Trabeculotomy/Goniotomy: usually performed in pediatric glaucoma cases, the blocked outflow channels are opened for improved drainage.

Goniosynechialysis: Adhesions of the iris to the drainage channel openings are gently broken, allowing fluid to reach the openings again.

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