Glaucoma Treatment in Gulbarga

Do I Need Glaucoma Surgery?

Most eye care providers will try eye drops—usually a combination of different eye drops—to lower eye pressure before turning to surgery. If you give non-surgical options a solid try and they still aren’t lowering your eye pressure, surgery is the next step.¹

For example, people who can’t tolerate daily eye drops are good candidates for surgery. Surgery may also be an option for people who have a hard time complying with eye drop use.²

Also, surgery is necessary to preserve vision if you are diagnosed with advanced glaucoma or have acute angle-closure glaucoma. Acute angle-closure glaucoma is when a blockage causes a rapid and dramatic increase in eye pressure.¹

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Types of Glaucoma Surgeries

There are a few different types of surgeries for glaucoma: minimally invasive glaucoma surgery (MIGS), laser treatment, trabeculectomy, and implant surgery.

Micro Invasive Glaucoma Surgery (MIGS)

Microinvasive glaucoma surgeries, known as MIGS, are usually used to treat mild to moderate glaucoma. They use microscopic stents and very tiny incisions to reduce eye pressure and have minimal complications compared to traditional glaucoma surgeries.²

A MIGS procedure results in minimal discomfort and can be relatively short, taking less than 10 minutes.³ Also, the different categories of MIGS procedures include:²

• Microtrabeculectomy: Microscopic tubes (stents) are inserted into the eye to drain fluid.

• Milder versions of laser photocoagulation: This type of procedure targets the ciliary body and stops it from producing so much fluid. These versions are gentler, though, and may be used in earlier stages of glaucoma.

• Trabecular bypass operations: A small incision is made in the trabecular meshwork, the area of spongy tissue between the cornea and iris that fluid drains through, and a tiny device is utilized to allow more fluid to pass through the natural drainage system. One type of device removes part of the meshwork; the other leaves behind a stent(s).

• Suprachoroidal shunts: This procedure uses shunts to connect the front of the eye to the suprachoroidal space—the space between the retina and the eye wall—to help fluid drain.

Laser Treatments

Laser procedures for glaucoma are often done in the eye surgeon’s office and have minimal recovery time involved. They aren’t permanent, though—typically, lasers need to be redone. They may also eventually require eye drops or more invasive surgeries to keep pressure under control. Sometimes, you may need to keep using eye drops even if you undergo laser treatment.⁴

The most common laser surgeries for glaucoma include:⁵⁶⁷

• Selective laser trabeculoplasty (SLT): A special laser is used to remodel the current drainage in the eye.

• Argon laser trabeculoplasty (ALT): Also used to treat open-angle glaucoma, ALT uses a laser to open up the drainage areas of the eye. Typically, half of the area is treated in one session, and then, if necessary, the other half will be treated at a later time. ALT is typically not effective a second time.

• Laser peripheral iridotomy (LPI):  The procedure creates a small hole in the outer edge of the iris to essentially open the angle in the eye so that fluid can freely drain through the meshwork. LPI can also be used preventively in people who have a narrow angle and are deemed high risk for glaucoma, even if they still have normal eye pressure.

• Laser cyclophotocoagulation: This type of laser is typically used in advanced glaucoma. It targets the ciliary body, the area behind the iris that actually makes the aqueous humor, to curb fluid production.

Trabeculectomy

Trabeculectomy is used for advanced glaucoma.⁸ During a trabeculectomy, the surgeon will make a small incision in the white part of your eye (the sclera) and remove a portion of the tissue so the eye can drain better.⁹

It’s typically an outpatient surgery—meaning you can leave the hospital the same day. Additionally, the procedure takes about an hour to complete.¹⁰

Implant Surgery

Implant surgery is a type of glaucoma surgery that involves inserting drainage tubes into the eye. This type of surgery is also typically used in more advanced glaucoma but can be especially useful in treating glaucoma that happens as a result of an eye injury, congenital glaucoma—in babies born with glaucoma—and neovascular glaucoma, which occurs when certain medical conditions cause blood vessels to overgrow in the eye and block the drainage area.¹⁰

This is also an in-hospital outpatient surgery where you’ll be awake but be given medicine to help with relaxation. The implant surgery procedure can be completed between one to two hours.¹⁰

What Are the Risks of Glaucoma Surgery?

Just like all surgeries, glaucoma surgery comes with risks, and some procedures are riskier than others. Still, you can reduce your risks and make the experience go more smoothly by working with a qualified and experienced eye surgeon who specializes in glaucoma surgeries.

MIGS procedures were created specifically to be less invasive and risky than other glaucoma surgery options. Some side effects of MIGS procedures are a short-term increase in eye pressure post-procedure and vision sharpness.²

Common side effects of laser surgeries include swelling and soreness. They can also cause dry eye or a scratched cornea—both of which can be painful but usually will heal quickly. Irritation and blurry vision are also common right after laser treatment, but side effects usually subside quickly.⁴

Invasive surgeries like trabeculectomy and implant surgery come with more risks, like infections. You may also experience side effects like cataracts, cornea problems, and vision loss.¹⁰

What To Expect After Surgery

Laser trabeculoplasty has a faster recovery time and doesn’t require a ride home, unlike the other procedures. With some surgeries, you won’t be able to return to all of your normal activities right away. In some cases, like with laser treatment, you might be able to resume your day like normal the day after treatment.⁴ In other cases, you may have to avoid some for up to four weeks.²

When your glaucoma surgery is complete, an eye care provider will prescribe eye drops. You’ll have to use the drops for weeks following the surgery to prevent infections or swelling from occurring.¹⁰

A Quick Review

Four types of procedures that can help treat glaucoma include MIGS, laser treatments, trabeculectomies, and implant surgeries. Despite the potential side effects, glaucoma surgeries can be very effective in lowering eye pressure and preserving the optic nerve. Recovery times may vary, but the procedures may ultimately be necessary to get your eye pressure in check and keep you from losing any vision to glaucoma.