Glaucoma Surgery Procedure - Trabeculectomy and Sclerectomy
The accompanying section is a manual for glaucoma medical procedure. I have made this manual for help get ready patients for glaucoma medical procedure. It is expected to enable patients to comprehend the "why" and "how" of glaucoma medical procedure.
Surgeries for glaucoma have been developing in the course of recent years. In the course of recent years, we have made huge walks in enhancing careful strategies and results. Glaucoma medical procedure is expected to bring down the intraocular weight (eye weight.) By bringing down the eye weight, we endeavor to back off movement of the malady. Glaucoma is characterized as harm to the optic nerve. Strangely raised eye weight is the most widely recognized reason for glaucomatous optic nerve harm. A few patients create glaucomatous optic nerve harm in spite of the way that they have intraocular weights inside ordinary range. These patients are said to have "low strain glaucoma." Sound individuals, who don't have glaucoma, have eye weights extending from 10mm to 20mm Hg. The normal weight among American grown-ups is 16mm Hg. Subsequently, glaucoma medical procedures are planned to bring down the eye weight to 16mm Hg or less. Medical procedure endeavors to bring down eye weight by making another "deplete" to enable watery liquid to leave the eye. Liquid which has left the eye through the new deplete gathers in a blister like cavity called a "bleb." From here, the liquid enters the venous course (veins) and leaves the circle.
About 15 to 25% of patients who have glaucoma don't have raised weights. These patients create harm to their optic nerves despite the fact that the eye weight once in a while achieves the mid-twenties. These patients have what we call "low strain glaucoma." The sorts of medical procedures performed on these patients are like the medical procedures performed on patients with lifted weights. The fundamental contrast in medical procedure for "low strain glaucoma" is that we are endeavoring to bring down the eye weight to 12mm Hg or less. This is a more forceful decrease than we go for in glaucomas because of lifted weights (16mm or less.)
Glaucoma medical procedure endeavors to bring down the eye weight by different techniques. These strategies will be obviously portrayed in the accompanying areas. Notwithstanding the technique utilized, it must be obvious to patients that it goes up against normal 3 to about a month and a half to recoup from medical procedure. This does not imply that the patient must be a "habitual slouch" amid this period, yet rather that they should basically "relax" amid this recuperation period. Numerous patients are happy with driving one to about fourteen days after medical procedure. A few patients, be that as it may, as to hold up no less than multi month to about a month and a half before driving.
IS THERE Agony Amid OR AFTER GLAUCOMA Medical procedure?
Patients who experience glaucoma medical procedure more often than not don't encounter noteworthy agony amid or after the medical procedure. Like any medical procedure, numerous patients encounter mellow distress for fourteen days following medical procedure. Solid torment drug isn't regularly required. Most patients who experience glaucoma medical procedure can accomplish great help with discomfort with Tylenol.
The most widely recognized dissension patients express after glaucoma medical procedure is that they feel a "scratchy" sensation for the initial 4 to about a month and a half. This is typical after glaucoma medical procedure! Patients are really feeling the fasten that is utilized to close the careful injury. This line is made of an absorbable material. This join breaks up over a time of 4 to about a month and a half. The fasten does not should be "evacuated" in light of the fact that is will break down consequently. The "scratchy" sensation can be limited by utilizing counterfeit tears. A few patients likewise utilize greasing up eye salves to enhance their solace.
Patient's may encounter foggy vision for the initial 3 to about a month and a half after medical procedure. The foggy vision can be exceptionally annoying to patients who don't expect this. In any case, if the 3 to multi week recuperation period is unmistakably disclosed and underlined to the patient, numerous patients don't experience issues amid this period.
Most patients don't require "glaucoma" eye drops after medical procedure. They do be that as it may, require three kinds of post-agent eye drops for the initial 2 to 3 months following medical procedure. They sorts of drops required include:
These three kinds of drops are utilized for about a few months after medical procedure. They enable the eye to recuperate at a controlled speed, avoid disease, and keep the eye moderately torment free. These drugs are once in a while utilized past 3 months following medical procedure
Glaucoma medical procedure is a successful technique for controlling the infection. The medical procedures, in any case, Don't "fix" glaucoma. The objectives of medical procedure are to bring down the weight in order to shield the optic nerve from proceeded with harm. The medical procedures don't reestablish locate which has just been lost. The medical procedures don't enhance vision. The essential objective of glaucoma medical procedure is to moderate the movement of the infection.
The weight decrease accomplished by medical procedure does NOT keep going forever. Contingent on the sort of medical procedure played out, a patient can would like to have their weight brought down from a time of a half year to 10 to 15 years. There are a large group of reasons why glaucoma medical procedures are not perpetual. The most widely recognized reason for disappointment of glaucoma medical procedure is scarring of the recently made waste section. Prescriptions are utilized to limit scarring for the initial couple of months following medical procedure. Through the span of 10 years, there is little we can do to take out scarring out and out.
Remember that recuperation takes between 3 to about a month and a half after medical procedure. Numerous patients start to stress that they are not mending appropriately in the event that they are not totally recuperated by a little while. It is essential to impart your feelings of trepidation to your specialists and enable them to mitigate any apprehensions, which may create after medical procedure.
WHAT Sorts OF GLAUCOMA Medical procedure ARE THERE?
I will now diagram every one of these medical procedures. The kind of medical procedure picked relies upon the sort and seriousness of glaucoma. Every patient has an alternate level of malady. The specialist will pick the kind of technique to perform dependent on every individual case.
Every medical procedure has focal points and weaknesses. There is no "immaculate" medical procedure. The objective is to pick the proper technique for every individual patient.
Glaucoma treatment is coordinated at ensuring the optic nerve and safeguarding visual capacity. At present, this objective is accomplished by bringing down intraocular weight utilizing meds, laser medications, or medical procedures. When all is said in done, medical procedure is saved for patients who have glaucoma, which has not been all around controlled on prescriptions, and have had finish laser treatment. Laser medications are normally performed after a patient's weight winds up uncontrolled on a maximally endured therapeutic regimen (MTMR.)
In spite of the fact that laser medications can be compelling, the weight decrease they deliver isn't perpetual. At the point when a patient has fizzled medicinal treatment, they more often than not experience laser treatment. At the point when laser treatment related to, or instead of therapeutic treatment comes up short, we depend on medical procedure. Despite the fact that medical procedure has verifiably been the keep going treatment on our rundown, this reasoning is evolving quickly. With advances in careful gadgets and strategies, the job of medical procedure is quickly developing. Medical procedure is never again seen "if all else fails." In specific cases, medical procedure might be a superior "initial step" than either drugs or laser medicines.
Glaucoma medical procedures endeavor to make a moderately perpetual "deplete" in the eye. This deplete will serve to expel fluid diversion from inside the eye to an additional visual repository.
The making of an opening or fistula is known as a trabeculectomy. Trabeculectomy initially increased across the board reputation in the 1970's. The methodology has been performed consistently since that time.
With glaucoma sifting medical procedure, trabecular meshwork and sclera are extracted, making a fistula through which fluid funniness channels from the front chamber. The fluid amusingness aggregates in the subconjunctival space, shaping a sifting bleb. In spite of the fact that it isn't known with conviction, fluid funniness inside a working sifting bleb is thought either to deplete through the conjunctiva into the tear-film, or to be assimilated from vessels inside episcleral and subconjunctival tissue and join the foundational course.
For most ophthalmic specialists, the signs are as per the following: A patient with glaucoma on greatest decent restorative treatment who has had maximal laser advantage and whose optic nerve work is coming up short or is probably going to come up short.
The specialist must be sure the patient has glaucoma, and not simply visual hypertension or nonglaucomatous optic neuropathy. This assurance suggests trademark harm to the optic nerve, visual field, or both.
Trabeculectomy is, fundamentally, a sifting technique intended to occupy the watery silliness through an eye-divider fistula (opening) to a subconjunctival separating store, the separating bleb. The objective of glaucoma separating medical procedure, similar to that of therapeutic and most laser treatments, is to bring down the intraocular weight (IOP) beneath the limit that causes optic nerve harm.
THE ROLE OF ANTI-METABOLITES:
The use of anti-metabolites during filtration surgery has greatly enhanced surgical success rates in high-risk eyes. These chemicals are applied to the eye at the time of surgery. They serve to decrease scaring of the surgically created wound. This allows the newly created glaucoma drain to remain open. Unfortunately, they are not without a significant downside. They have been shown to increase the rate of post-operative infection. In addition, they increase the incidence of postoperative wound leak. Intra-operative or post-operative use of 5-fluorouracil (5-FU) or mitomycin C (MMC), to limit scarring following glaucoma filtering surgery can improve the surgical outcome of an eye with a poor prognosis.
POST-OPERATIVE COURSE:
Glaucoma surgery attempts to lower the intraocular pressure without the aid of glaucoma medicines. During the early postoperative period, the intraocular pressure can by variable. In some patients, the pressure is quite low. In other patients, the postoperative pressure can be higher than it was before surgery.
When the pressure fluctuates, often a patient’s vision will fluctuate. Patients often experience blurred and frankly poor vision for the first 6 weeks after surgery. Fortunately, by the beginning of the second month following surgery, vision usually returns to its preoperative level and stays there. One of the paramount goals of glaucoma surgery is to minimize an individual’s dependence on glaucoma medication. Although this is not achieved in 100% of cases, it is certainly attainable in a good number. The following pages illustrate and describe a surgical trabeculectomy.
1. TRABECULECTOMY lowers the pressure inside the eye! They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.
2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal immediately after surgery. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on their own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches dissolve spontaneously. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.
5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. In fact, we hope to have a good-sized bleb because this is where your new drain is. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!
6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)-955-1000.
GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES (GDD) OR AQUEOUS SHUNTS
During the past two decades, glaucoma drainage devices (GDD’s) have been increasingly used in the treatment of glaucoma. Approximately 5000 GDD’s are used in the United States annually. Most GDD’s consist of a segment of silicone rubber tubing attached to a rigid plastic or flexible silicone rubber explant.
As previously discussed, glaucoma occurs when the pressure in the eye becomes elevated. The pressure usually becomes elevated due to damage to the natural drain within the eye. GDD’s work by “shunting” excess fluid out of the eye through the silicone rubber tubing. Once removed from the eye, the fluid joins with venous blood, which is returned to the heart
Over the past 5 years, the use of GDD’s has grown rapidly. This increase is due to both improved devices, as well as improved surgical techniques.
GDD’s are less prone to failure than traditional “trabeculectomy” because they are less effected by post surgical scarring. An important advantage which GDD’s have over trabeculectomy is that they do not leave the eye as susceptible to infections following otherwise successful surgery.
The following illustration displays several types of GDD architecture.
The first GDD was the Malteno glaucoma implant, which initially appeared in 1969. Commercially manufactured GDD’s currently available in the U.S. included both “valved” or “flow-restricted” designs (Ahmed, Krupin) and “nonvalved” (Malteno, Baerveldt) designs. While differing in size, shape, and details of instillation, all of these devices share common features and utilize the same physiologic principles.
The human eye produces a clear, water-like, fluid called aqueous humor. In a healthy individual, this fluid is drained out of the eye at the same rate it is produced. In patients with glaucoma, the eye loses its ability to drain the fluid out as fast as it is being produced. As a consequence, the aqueous humor accumulates in the eye and the pressure within the eye increases. The increase in pressure leads to damage of structures within the eye. The structure within the eye which is most susceptible to increased pressure is the optic nerve. Thus, glaucoma is defined as damage to the optic nerve resulting from increased intraocular pressure.
As we have discussed, patients with glaucoma usually have a damaged drainage system. GDD’s lower pressure because they allow the excess fluid to bypass the damaged drainage system. GDD’s work by “shunting” fluid out of the eye. They consist of a one way drain attached to a straw like piece of tubing. The drain is referred to as the “plate.” The tubing is surgically inserted into the eye. It runs from inside the eye to the plate, which is sutured onto the outside of the eye. Thus, aqueous humor is shunted from inside the eye to the plate, where it is absorbed by blood vessels, which return it to the systemic circulation.
INDICATIONS:
The general indications for installing GDD’s include failure of conventional therapies such as medications, laser trabeculoplasty, and standard trabeculectomy with or without antifibrotic agents.
GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES
POST-OPERATIVE COURSE:
GDD’s have demonstrated, as do some trabeculectomies, a period of elevated pressure before the ultimate lowering occurs. Intraocular pressure often falls initially, and then rises to preoperative levels or even higher for weeks before falling again. Resumption of medications is indicated to minimize the transient pressure rise.
POST-OPERATIVE MEDICATIONS:
Post-operative medications following GDD surgery include topical corticosteroids such as Pred Forte 1% from 4 to 6 times a day. In addition, topical antibiotic (Ciloxan, Oxuflox) drops should be used. Glaucoma medications will usually need to be resumed promptly after placement of a GDD, pending spontaneous or surgical opening of the tube as the absorbable ligature dissolves or is cut with a laser
Complication rates for GDD’s have fallen drastically over the past decade due to improved knowledge and experience with the devices. In general, the most common complications seen with any ocular surgery are bleeding, or infection, which in the worst-case scenario, can lead to total blindness and loss of the eye. The most common short term complication is low pressure. The major long-term problems seen with GDD’s are double vision, and corneal decompensation. The reasons for double vision are varied and not always predictable. Corneal decompensation occurs when the tube migrates and comes into contact with the inner surface of the cornea. Both of these problems can be surgically remedied. Double vision can be remedied by removing the GDD. Corneal decompensation can be improved by corneal transplantation.
FIGURE A.
The conjunctiva has been opened. The supero-temporal Quadrant has been exposed. The superior and lateral rectus muscles have been isolated. The plate is placed under the superior rectus muscle.
FIGURE B:
The plate is placed under the lateral rectus muscle. You can see the tube attached to the plate. In this picture, the tube has not yet been placed into the eye.
FIGURE C:
The tube has been placed into the eye. The tube is covered with a square piece of donor sclera or pericardium. As you can see, the tube sits in the anterior chamber (front of the eye). The conjunctiva has not yet been closed.
POST-OPERATIVE PATIENT INFORMATION
GLAUCOMA DRAINAGE DEVICE SURGERY:
ANDREW RABINOWITZ, M.D.
1. GLAUCOMA DRAINAGE DEVICES lower the pressure inside the eye!. They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.
2. DOUBLE VISION IS NORMAL AFTER THIS SURGERY! .
It is not unusual to experience double or triple vision after this type of surgery.
The double vision is usually worst during the first 3 weeks and then slowly improves over the first 3 months. Many patients become alarmed when they experience double vision, but I stress that this is a normal occurrence, and does not mean that something has gone wrong with your surgery. Some people find that patching the eye for a few weeks makes the double vision go away. There is not harm in covering the operated eye even during the daytime to lessen the double vision. I often recommend this to patients who experience double vision.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY
5. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
6. IT TAKES 6 WEEKS BEFORE THE SHUNT LOWERS EYE PRESSURE!
The drainage device is used to control pressure by shunting fluid out of the eye. The device, however, is designed to lower the pressure gradually over 6 weeks following surgery. In fact, the drain does not work at all for the first month after surgery. After that time, it slowly starts to drain out the fluid and lower the pressure. By six weeks after surgery, the drain will be working at full capacity.
7. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
If you experience any of these, please call our office immediately at (602)=955-1000.
GLAUCOMA SURGERY-DEEP SCLERECTOMY WITH VISCOCANALOSTOMY (DSVC)
The most commonly performed glaucoma procedure in the United States is the trabeculectomy. Trabeculectomy attempts to make a partial hole in the white part of the eye (sclera). Aqueous humor drains through this hole into a small blister-like cyst known as the “bleb.” Unfortunately, the bleb obtained in successful glaucoma surgery has many unfavorable characteristics. Firstly, the bleb may be elevated, causing the patient to feel as though there is something in their eye. Secondly, large blebs can grow onto the cornea and become cosmetically unacceptable. Finally, blebs make the eye susceptible to severe infections. The risks of developing a profound infection leading to blindness are much greater in eyes with functioning blebs.
Glaucoma surgeons have spent the past decade attempting to invent a glaucoma surgery which does not result in the creation of a bleb. DSVC attempts to bypass the obstructed trabecular meshwork without creating a scleral hole or fistula. DSVC is referred to as non-penetrating filtration because no hole is created in the eye as is done with trabeculectomy.
DSVC involves the creation of a drainage channel without creating a full thickness hole in the sclera. Theoretically, this will greatly decrease the incidence of post-operative wound leaks and infections. In addition, because no hole is made, the surgery is less susceptible to failure because scarring is less critical to the long-term success of the surgery.
DSVC is a surgery in its infancy. The results of our initial experience with DSVC are encouraging enough to stimulate significant worldwide interest in his procedure.
I have performed over 200 of these procedures with promising results. The rate of postoperative complications has been lower than that seen with trabeculectomy. Bleb formation does occur in about 25% of cases. These blebs however, are low lying, and usually disappear by 6 months. The intraocular pressure has remained controlled even in
cases in which the bleb becomes extinct.
DSVC will not completely replace conventional filtration surgery. However, it will likely assume a crucial role as an alternative to trabeculectomy. DSVC may in fact become the treatment of choice in juvenile glaucomas, pigmentary glaucomas, and open angle glaucomas in myopic eyes. Results of DSVC have been less favorable in far-sighted patients, and eyes with inflammatory glaucomas.
Further studies and refinement of the technique will undoubtedly push the envelope of glaucoma surgery. DSVC offers an excellent alternative to trabeculectomy. This is important in patients who have undergone unsuccessful trabeculectomy in one eye and require initial surgery in the fellow eye.
In glaucoma, hope springs eternal. Clinical trials are underway for another novel glaucoma surgery, which involves using a synthetic “wick” to draw aqueous fluid out of the eye through a non-penetrating scleral reservoir. We hope to participate in this international clinical trial in the coming months. This would enable The Barnet Dulaney Eye Center to offer cutting-edge surgical treatment for glaucoma.
1. DEEP SCLERECTOMY lowers the pressure inside the eye. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream. The fluid removed from your eye does not join with your tears.
2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches are self-absorbing. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.
5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!
6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)=955-1000.
GLAUCOMA SURGERY:-TRANS-SCLERAL LASER CYCLOPHOTOCOAGULATION (CPC)
The cyclodestructive procedures are also useful in patients in whom conventional surgery is contraindicated by their systemic health or local ocular condition. Generally, these patients have little or no functional vision. Reduction of intraocular induced pain in this clinical setting is an important indication.
WHO IS A CANDIDATE FOR CPC Surgery?
CPC is reserved for patients who undergone multiple eye surgeries including glaucoma surgeries who still have elevated eye pressure. Often, these patients have lost a significant amount if not all of their vision
2. A painful eye with little or no sight remaining.
3. Uncontrolled glaucoma in a patient who is not a good surgical candidate.
4. Reduction of pain in a blind eye.
HOW DOES THE LASER GET TO THE EYE?
The laser energy is delivered to the eye through a probe, which resembles a pen.
The entire procedure usually takes 2 to 5 minutes. The procedure is well tolerated because the patient is treated with a local anesthetic prior to the treatment. The treatment does not require any incisions, sutures, or needles.
About Glaucoma Surgery
Surgeries for glaucoma have been developing in the course of recent years. In the course of recent years, we have made huge walks in enhancing careful strategies and results. Glaucoma medical procedure is expected to bring down the intraocular weight (eye weight.) By bringing down the eye weight, we endeavor to back off movement of the malady. Glaucoma is characterized as harm to the optic nerve. Strangely raised eye weight is the most widely recognized reason for glaucomatous optic nerve harm. A few patients create glaucomatous optic nerve harm in spite of the way that they have intraocular weights inside ordinary range. These patients are said to have "low strain glaucoma." Sound individuals, who don't have glaucoma, have eye weights extending from 10mm to 20mm Hg. The normal weight among American grown-ups is 16mm Hg. Subsequently, glaucoma medical procedures are planned to bring down the eye weight to 16mm Hg or less. Medical procedure endeavors to bring down eye weight by making another "deplete" to enable watery liquid to leave the eye. Liquid which has left the eye through the new deplete gathers in a blister like cavity called a "bleb." From here, the liquid enters the venous course (veins) and leaves the circle.
About 15 to 25% of patients who have glaucoma don't have raised weights. These patients create harm to their optic nerves despite the fact that the eye weight once in a while achieves the mid-twenties. These patients have what we call "low strain glaucoma." The sorts of medical procedures performed on these patients are like the medical procedures performed on patients with lifted weights. The fundamental contrast in medical procedure for "low strain glaucoma" is that we are endeavoring to bring down the eye weight to 12mm Hg or less. This is a more forceful decrease than we go for in glaucomas because of lifted weights (16mm or less.)
GLAUCOMA Medical Procedure
Glaucoma medical procedure endeavors to bring down the eye weight by different techniques. These strategies will be obviously portrayed in the accompanying areas. Notwithstanding the technique utilized, it must be obvious to patients that it goes up against normal 3 to about a month and a half to recoup from medical procedure. This does not imply that the patient must be a "habitual slouch" amid this period, yet rather that they should basically "relax" amid this recuperation period. Numerous patients are happy with driving one to about fourteen days after medical procedure. A few patients, be that as it may, as to hold up no less than multi month to about a month and a half before driving.
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Glaucoma Surgery Procedure |
IS THERE Agony Amid OR AFTER GLAUCOMA Medical procedure?
Patients who experience glaucoma medical procedure more often than not don't encounter noteworthy agony amid or after the medical procedure. Like any medical procedure, numerous patients encounter mellow distress for fourteen days following medical procedure. Solid torment drug isn't regularly required. Most patients who experience glaucoma medical procedure can accomplish great help with discomfort with Tylenol.
The most widely recognized dissension patients express after glaucoma medical procedure is that they feel a "scratchy" sensation for the initial 4 to about a month and a half. This is typical after glaucoma medical procedure! Patients are really feeling the fasten that is utilized to close the careful injury. This line is made of an absorbable material. This join breaks up over a time of 4 to about a month and a half. The fasten does not should be "evacuated" in light of the fact that is will break down consequently. The "scratchy" sensation can be limited by utilizing counterfeit tears. A few patients likewise utilize greasing up eye salves to enhance their solace.
Foggy Vision after Glaucoma Surgery
Patient's may encounter foggy vision for the initial 3 to about a month and a half after medical procedure. The foggy vision can be exceptionally annoying to patients who don't expect this. In any case, if the 3 to multi week recuperation period is unmistakably disclosed and underlined to the patient, numerous patients don't experience issues amid this period.
Eyedrops after Glaucoma SURGERY
Most patients don't require "glaucoma" eye drops after medical procedure. They do be that as it may, require three kinds of post-agent eye drops for the initial 2 to 3 months following medical procedure. They sorts of drops required include:
- An anti-microbial
- A calming (typically prednisone)
- A medicine to widen the understudy (this is utilized to help keep the eye agreeable.)
These three kinds of drops are utilized for about a few months after medical procedure. They enable the eye to recuperate at a controlled speed, avoid disease, and keep the eye moderately torment free. These drugs are once in a while utilized past 3 months following medical procedure
Glaucoma Surgery Reasons
Glaucoma medical procedure is a successful technique for controlling the infection. The medical procedures, in any case, Don't "fix" glaucoma. The objectives of medical procedure are to bring down the weight in order to shield the optic nerve from proceeded with harm. The medical procedures don't reestablish locate which has just been lost. The medical procedures don't enhance vision. The essential objective of glaucoma medical procedure is to moderate the movement of the infection.
The weight decrease accomplished by medical procedure does NOT keep going forever. Contingent on the sort of medical procedure played out, a patient can would like to have their weight brought down from a time of a half year to 10 to 15 years. There are a large group of reasons why glaucoma medical procedures are not perpetual. The most widely recognized reason for disappointment of glaucoma medical procedure is scarring of the recently made waste section. Prescriptions are utilized to limit scarring for the initial couple of months following medical procedure. Through the span of 10 years, there is little we can do to take out scarring out and out.
Remember that recuperation takes between 3 to about a month and a half after medical procedure. Numerous patients start to stress that they are not mending appropriately in the event that they are not totally recuperated by a little while. It is essential to impart your feelings of trepidation to your specialists and enable them to mitigate any apprehensions, which may create after medical procedure.
WHAT Sorts OF GLAUCOMA Medical procedure ARE THERE?
- Trabeculectomy
- Glaucoma Seepage Gadgets (Fluid shunts)
- Non-infiltrating filtration systems (Water Stream)
- Diode laser cyclodrestruction
I will now diagram every one of these medical procedures. The kind of medical procedure picked relies upon the sort and seriousness of glaucoma. Every patient has an alternate level of malady. The specialist will pick the kind of technique to perform dependent on every individual case.
Every medical procedure has focal points and weaknesses. There is no "immaculate" medical procedure. The objective is to pick the proper technique for every individual patient.
GLAUCOMA Surgery Procedure TRABECULECTOMY
Glaucoma treatment is coordinated at ensuring the optic nerve and safeguarding visual capacity. At present, this objective is accomplished by bringing down intraocular weight utilizing meds, laser medications, or medical procedures. When all is said in done, medical procedure is saved for patients who have glaucoma, which has not been all around controlled on prescriptions, and have had finish laser treatment. Laser medications are normally performed after a patient's weight winds up uncontrolled on a maximally endured therapeutic regimen (MTMR.)
In spite of the fact that laser medications can be compelling, the weight decrease they deliver isn't perpetual. At the point when a patient has fizzled medicinal treatment, they more often than not experience laser treatment. At the point when laser treatment related to, or instead of therapeutic treatment comes up short, we depend on medical procedure. Despite the fact that medical procedure has verifiably been the keep going treatment on our rundown, this reasoning is evolving quickly. With advances in careful gadgets and strategies, the job of medical procedure is quickly developing. Medical procedure is never again seen "if all else fails." In specific cases, medical procedure might be a superior "initial step" than either drugs or laser medicines.
Glaucoma medical procedures endeavor to make a moderately perpetual "deplete" in the eye. This deplete will serve to expel fluid diversion from inside the eye to an additional visual repository.
The making of an opening or fistula is known as a trabeculectomy. Trabeculectomy initially increased across the board reputation in the 1970's. The methodology has been performed consistently since that time.
Trabeculectomy Surgery for Glaucoma
With glaucoma sifting medical procedure, trabecular meshwork and sclera are extracted, making a fistula through which fluid funniness channels from the front chamber. The fluid amusingness aggregates in the subconjunctival space, shaping a sifting bleb. In spite of the fact that it isn't known with conviction, fluid funniness inside a working sifting bleb is thought either to deplete through the conjunctiva into the tear-film, or to be assimilated from vessels inside episcleral and subconjunctival tissue and join the foundational course.
TRABECULECTOMY Symptoms
For most ophthalmic specialists, the signs are as per the following: A patient with glaucoma on greatest decent restorative treatment who has had maximal laser advantage and whose optic nerve work is coming up short or is probably going to come up short.
The specialist must be sure the patient has glaucoma, and not simply visual hypertension or nonglaucomatous optic neuropathy. This assurance suggests trademark harm to the optic nerve, visual field, or both.
TRABECULECTOMY Procedure:
Trabeculectomy is, fundamentally, a sifting technique intended to occupy the watery silliness through an eye-divider fistula (opening) to a subconjunctival separating store, the separating bleb. The objective of glaucoma separating medical procedure, similar to that of therapeutic and most laser treatments, is to bring down the intraocular weight (IOP) beneath the limit that causes optic nerve harm.
THE ROLE OF ANTI-METABOLITES:
The use of anti-metabolites during filtration surgery has greatly enhanced surgical success rates in high-risk eyes. These chemicals are applied to the eye at the time of surgery. They serve to decrease scaring of the surgically created wound. This allows the newly created glaucoma drain to remain open. Unfortunately, they are not without a significant downside. They have been shown to increase the rate of post-operative infection. In addition, they increase the incidence of postoperative wound leak. Intra-operative or post-operative use of 5-fluorouracil (5-FU) or mitomycin C (MMC), to limit scarring following glaucoma filtering surgery can improve the surgical outcome of an eye with a poor prognosis.
TRABECULECTOMY RISKS
The risks of glaucoma surgery include bleeding, infection, blindness, and loss of the eye. These risks are not unique to glaucoma surgery. However, eyes with glaucoma are usually “sicker” than eyes without glaucoma. Despite these risks, the benefits of long-term pressure reduction are great. Numerous scientific studies have repeatedly demonstrated that patient’s whose pressures are lowered by at least 30% from their untreated levels have better preservation of visual function over the course of their lifetime.POST-OPERATIVE COURSE:
Glaucoma surgery attempts to lower the intraocular pressure without the aid of glaucoma medicines. During the early postoperative period, the intraocular pressure can by variable. In some patients, the pressure is quite low. In other patients, the postoperative pressure can be higher than it was before surgery.
When the pressure fluctuates, often a patient’s vision will fluctuate. Patients often experience blurred and frankly poor vision for the first 6 weeks after surgery. Fortunately, by the beginning of the second month following surgery, vision usually returns to its preoperative level and stays there. One of the paramount goals of glaucoma surgery is to minimize an individual’s dependence on glaucoma medication. Although this is not achieved in 100% of cases, it is certainly attainable in a good number. The following pages illustrate and describe a surgical trabeculectomy.
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Trabeculectomy Surgery Photo |
TRABECULECTOMY SURGERY INFORMATION
1. TRABECULECTOMY lowers the pressure inside the eye! They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.
2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal immediately after surgery. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on their own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches dissolve spontaneously. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.
5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. In fact, we hope to have a good-sized bleb because this is where your new drain is. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!
6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)-955-1000.
GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES (GDD) OR AQUEOUS SHUNTS
During the past two decades, glaucoma drainage devices (GDD’s) have been increasingly used in the treatment of glaucoma. Approximately 5000 GDD’s are used in the United States annually. Most GDD’s consist of a segment of silicone rubber tubing attached to a rigid plastic or flexible silicone rubber explant.
As previously discussed, glaucoma occurs when the pressure in the eye becomes elevated. The pressure usually becomes elevated due to damage to the natural drain within the eye. GDD’s work by “shunting” excess fluid out of the eye through the silicone rubber tubing. Once removed from the eye, the fluid joins with venous blood, which is returned to the heart
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| Eye have glaucoma |
Over the past 5 years, the use of GDD’s has grown rapidly. This increase is due to both improved devices, as well as improved surgical techniques.
GDD’s are less prone to failure than traditional “trabeculectomy” because they are less effected by post surgical scarring. An important advantage which GDD’s have over trabeculectomy is that they do not leave the eye as susceptible to infections following otherwise successful surgery.
The following illustration displays several types of GDD architecture.
The first GDD was the Malteno glaucoma implant, which initially appeared in 1969. Commercially manufactured GDD’s currently available in the U.S. included both “valved” or “flow-restricted” designs (Ahmed, Krupin) and “nonvalved” (Malteno, Baerveldt) designs. While differing in size, shape, and details of instillation, all of these devices share common features and utilize the same physiologic principles.
GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES
The human eye produces a clear, water-like, fluid called aqueous humor. In a healthy individual, this fluid is drained out of the eye at the same rate it is produced. In patients with glaucoma, the eye loses its ability to drain the fluid out as fast as it is being produced. As a consequence, the aqueous humor accumulates in the eye and the pressure within the eye increases. The increase in pressure leads to damage of structures within the eye. The structure within the eye which is most susceptible to increased pressure is the optic nerve. Thus, glaucoma is defined as damage to the optic nerve resulting from increased intraocular pressure.
As we have discussed, patients with glaucoma usually have a damaged drainage system. GDD’s lower pressure because they allow the excess fluid to bypass the damaged drainage system. GDD’s work by “shunting” fluid out of the eye. They consist of a one way drain attached to a straw like piece of tubing. The drain is referred to as the “plate.” The tubing is surgically inserted into the eye. It runs from inside the eye to the plate, which is sutured onto the outside of the eye. Thus, aqueous humor is shunted from inside the eye to the plate, where it is absorbed by blood vessels, which return it to the systemic circulation.
INDICATIONS:
The general indications for installing GDD’s include failure of conventional therapies such as medications, laser trabeculoplasty, and standard trabeculectomy with or without antifibrotic agents.
GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICES
POST-OPERATIVE COURSE:
GDD’s have demonstrated, as do some trabeculectomies, a period of elevated pressure before the ultimate lowering occurs. Intraocular pressure often falls initially, and then rises to preoperative levels or even higher for weeks before falling again. Resumption of medications is indicated to minimize the transient pressure rise.
POST-OPERATIVE MEDICATIONS:
Post-operative medications following GDD surgery include topical corticosteroids such as Pred Forte 1% from 4 to 6 times a day. In addition, topical antibiotic (Ciloxan, Oxuflox) drops should be used. Glaucoma medications will usually need to be resumed promptly after placement of a GDD, pending spontaneous or surgical opening of the tube as the absorbable ligature dissolves or is cut with a laser
GLAUCOMA DRAINAGE DEVICES COMPLICATIONS?
Complication rates for GDD’s have fallen drastically over the past decade due to improved knowledge and experience with the devices. In general, the most common complications seen with any ocular surgery are bleeding, or infection, which in the worst-case scenario, can lead to total blindness and loss of the eye. The most common short term complication is low pressure. The major long-term problems seen with GDD’s are double vision, and corneal decompensation. The reasons for double vision are varied and not always predictable. Corneal decompensation occurs when the tube migrates and comes into contact with the inner surface of the cornea. Both of these problems can be surgically remedied. Double vision can be remedied by removing the GDD. Corneal decompensation can be improved by corneal transplantation.GLAUCOMA DRAINAGE Results
GDD’s offer an excellent alternative to conventional filtration surgery. Surgery should be performed by a surgeon with broad experience with GDD’s. Once functioning, GDD’s can provide good long-term intraocular pressure reduction and glaucoma control. Unfortunately like all glaucoma procedures, the pressure control produced by these devices is not always permanent. However, GDD’s offer the most predictable long-term pressure control for glaucoma patients.GLAUCOMA SURGERY-GLAUCOMA DRAINAGE DEVICESSURGICAL PROCEDURE
The white part of the eye is called the sclera. The sclera is covered with a thin, film-like layer of clear tissue known as the conjunctiva. Surgery involves opening the conjunctiva thereby exposing the sclera. The drainage device is then placed in a selected quadrant and sutured to the sclera. The tube is then inserted into the eye through a tract created by a small needle. The tube is then temporarily closed off with an absorbable suture and anchored to the sclera. The tube is then covered with a piece of donor sclera or pericardium. The conjunctiva is then closed in a watertight fashion, completely covering the drainage device and the tube.FIGURE A.
The conjunctiva has been opened. The supero-temporal Quadrant has been exposed. The superior and lateral rectus muscles have been isolated. The plate is placed under the superior rectus muscle.
FIGURE B:
The plate is placed under the lateral rectus muscle. You can see the tube attached to the plate. In this picture, the tube has not yet been placed into the eye.
FIGURE C:
The tube has been placed into the eye. The tube is covered with a square piece of donor sclera or pericardium. As you can see, the tube sits in the anterior chamber (front of the eye). The conjunctiva has not yet been closed.
POST-OPERATIVE PATIENT INFORMATION
GLAUCOMA DRAINAGE DEVICE SURGERY:
ANDREW RABINOWITZ, M.D.
1. GLAUCOMA DRAINAGE DEVICES lower the pressure inside the eye!. They do not cause the fluid to drain into your tears. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream.
2. DOUBLE VISION IS NORMAL AFTER THIS SURGERY! .
It is not unusual to experience double or triple vision after this type of surgery.
The double vision is usually worst during the first 3 weeks and then slowly improves over the first 3 months. Many patients become alarmed when they experience double vision, but I stress that this is a normal occurrence, and does not mean that something has gone wrong with your surgery. Some people find that patching the eye for a few weeks makes the double vision go away. There is not harm in covering the operated eye even during the daytime to lessen the double vision. I often recommend this to patients who experience double vision.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY
5. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
6. IT TAKES 6 WEEKS BEFORE THE SHUNT LOWERS EYE PRESSURE!
The drainage device is used to control pressure by shunting fluid out of the eye. The device, however, is designed to lower the pressure gradually over 6 weeks following surgery. In fact, the drain does not work at all for the first month after surgery. After that time, it slowly starts to drain out the fluid and lower the pressure. By six weeks after surgery, the drain will be working at full capacity.
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| Iridectomy and Bleb |
7. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
If you experience any of these, please call our office immediately at (602)=955-1000.
GLAUCOMA SURGERY-DEEP SCLERECTOMY WITH VISCOCANALOSTOMY (DSVC)
The most commonly performed glaucoma procedure in the United States is the trabeculectomy. Trabeculectomy attempts to make a partial hole in the white part of the eye (sclera). Aqueous humor drains through this hole into a small blister-like cyst known as the “bleb.” Unfortunately, the bleb obtained in successful glaucoma surgery has many unfavorable characteristics. Firstly, the bleb may be elevated, causing the patient to feel as though there is something in their eye. Secondly, large blebs can grow onto the cornea and become cosmetically unacceptable. Finally, blebs make the eye susceptible to severe infections. The risks of developing a profound infection leading to blindness are much greater in eyes with functioning blebs.
Glaucoma surgeons have spent the past decade attempting to invent a glaucoma surgery which does not result in the creation of a bleb. DSVC attempts to bypass the obstructed trabecular meshwork without creating a scleral hole or fistula. DSVC is referred to as non-penetrating filtration because no hole is created in the eye as is done with trabeculectomy.
DSVC involves the creation of a drainage channel without creating a full thickness hole in the sclera. Theoretically, this will greatly decrease the incidence of post-operative wound leaks and infections. In addition, because no hole is made, the surgery is less susceptible to failure because scarring is less critical to the long-term success of the surgery.
DSVC is a surgery in its infancy. The results of our initial experience with DSVC are encouraging enough to stimulate significant worldwide interest in his procedure.
I have performed over 200 of these procedures with promising results. The rate of postoperative complications has been lower than that seen with trabeculectomy. Bleb formation does occur in about 25% of cases. These blebs however, are low lying, and usually disappear by 6 months. The intraocular pressure has remained controlled even in
cases in which the bleb becomes extinct.
DSVC will not completely replace conventional filtration surgery. However, it will likely assume a crucial role as an alternative to trabeculectomy. DSVC may in fact become the treatment of choice in juvenile glaucomas, pigmentary glaucomas, and open angle glaucomas in myopic eyes. Results of DSVC have been less favorable in far-sighted patients, and eyes with inflammatory glaucomas.
Further studies and refinement of the technique will undoubtedly push the envelope of glaucoma surgery. DSVC offers an excellent alternative to trabeculectomy. This is important in patients who have undergone unsuccessful trabeculectomy in one eye and require initial surgery in the fellow eye.
In glaucoma, hope springs eternal. Clinical trials are underway for another novel glaucoma surgery, which involves using a synthetic “wick” to draw aqueous fluid out of the eye through a non-penetrating scleral reservoir. We hope to participate in this international clinical trial in the coming months. This would enable The Barnet Dulaney Eye Center to offer cutting-edge surgical treatment for glaucoma.
SCLERECTOMY SURGERY PROCEDURES
1. DEEP SCLERECTOMY lowers the pressure inside the eye. The fluid, which is drained out of your eye, is shunted to the back of the eye, and from there it enters the venous system to be removed from the eye as it mixes into the bloodstream. The fluid removed from your eye does not join with your tears.
2. BLURRY VISION IS NORMAL AFTER THIS SURGERY!
Your vision will be very blurry for the first 3 to 6 weeks following this surgery. Many patients become anxious during the first month after surgery because their vision does not return to normal rapidly. I cannot over-emphasize that it is normal to have very blurry vision for 6 full weeks following the surgery. It is important to keep this in mind so as not to become worried that something has gone wrong with your surgery.
3. WATERING OF THE EYE IS NORMAL AFTER SURGERY!
Tearing, watering, and mattering are all common complaints after this type of surgery. The excessive tearing and watering will resolve on its own over the first 3 to 6 weeks. It is not a permanent problem. Be patient, this problem is very common, but always resolves spontaneously over time.
4. A SCRATCHY OR “SANDY” SENSATION IS NORMAL AFTER SURGERY!
Glaucoma surgery requires stitches (sutures). The stitches are self-absorbing. It takes about 3 to 6 weeks for the stitches to dissolve. During this period, you may feel the stitch scratching the eye. This is NORMAL! Some people feel this scratchy sensation a few days after surgery; some do not experience it until many weeks after surgery. Do not be alarmed if you experience this. One way to lessen the discomfort is to use an eye ointment, which your doctor can prescribe for you in the office, or call it in to your pharmacy. There are also over the counter ointments available, which your doctor may recommend. The ointments lubricate the stitches and minimize the friction between the stitches and your eyelids. The ointments help the comfort of the eye but can cause blurry vision because they are very thick. They are very helpful if used before going to sleep because they will have minimal effect on your vision, and keep the eye moist when you sleep. They might cause your eye to be stuck shut in the morning, but this can easily be removed with a cool compress.
5. YOU WILL NOTICE A CYST ON THE UPPER PART OF YOUR EYE!
This cyst is called a “bleb.” This is a normal occurrence. The bleb often looks like a blister. Do not be alarmed if you see it. It is supposed to be there!
6. SEVERE PAIN, HEADACHE AND NAUSEA ARE NOT NORMAL!
MUCUS, PUS, OR GREEN-YELLOW DISCHARGE IS NOT NORMAL.
If you experience any of these, please call our office immediately at (602)=955-1000.
GLAUCOMA SURGERY:-TRANS-SCLERAL LASER CYCLOPHOTOCOAGULATION (CPC)
Cpc Surgery
The ciliary body is the structure that produces aqueous humor. Aqueous humor is a clear liquid. This liquid is responsible for keeping the eye formed. Cyclodestruction is a treatment, which destroys cells of the ciliary body. In so doing, the treatment attempts to shut down the production of fluid within the eye. Cyclodestructive procedures are recommended in patients with advanced glaucomas and otherwise poor prognoses. Often these patients have been relative failures of medical therapy and glaucoma filtering surgery. In many respects, CPC can be viewed as a “last-step effort to save the eye.”The cyclodestructive procedures are also useful in patients in whom conventional surgery is contraindicated by their systemic health or local ocular condition. Generally, these patients have little or no functional vision. Reduction of intraocular induced pain in this clinical setting is an important indication.
WHO IS A CANDIDATE FOR CPC Surgery?
CPC is reserved for patients who undergone multiple eye surgeries including glaucoma surgeries who still have elevated eye pressure. Often, these patients have lost a significant amount if not all of their vision
WHAT ARE THE INDICATIONS FOR CPC Surgery?
1. Persistently elevated eye pressure despite aggressive surgical treatment.2. A painful eye with little or no sight remaining.
3. Uncontrolled glaucoma in a patient who is not a good surgical candidate.
4. Reduction of pain in a blind eye.
HOW DOES THE LASER GET TO THE EYE?
The laser energy is delivered to the eye through a probe, which resembles a pen.
The entire procedure usually takes 2 to 5 minutes. The procedure is well tolerated because the patient is treated with a local anesthetic prior to the treatment. The treatment does not require any incisions, sutures, or needles.
