Glaucoma is an eye disease in which pressure inside the eye, also known as intraocular pressure, rises to a level that causes damage to the optic nerve causing vision loss or blindness. Clear eye fluid is produced by the ciliary body which enters the eye and drains out of the eye through tiny passages known as the trabecular meshwork. People with glaucoma are unable to drain the fluid effectively which results in a rise of intraocular pressure.
Some cases of glaucoma can be treated with medications. Other cases require either laser or traditional surgery to lower eye pressure. Of the two types of surgery, laser surgery is the most frequently used procedure in the treatment of glaucoma. Conventional surgery is usually performed after all other treatment methods for glaucoma, including laser surgery, have proven unsuccessful. In deciding what method of surgery to treat glaucoma, your surgeon will take into consideration your medical health and history, and the severity of your condition.
YAG laser surgery is the most up-to-date form of treatment for several eye conditions. Most commonly, it is performed to treat a film that may occur after cataract surgery and several types of glaucoma. The surgery, which utilizes advanced laser techniques, is precise, safe and often highly successful. Since glaucoma is a disorder in which there is high pressure in the fluid of the eye, the surgical procedure is designed to promote drainage. At times, YAG surgery may effect an almost complete lowering of eye pressure, but in many cases prescribed eye drops will still be required. Following are three types of YAG surgery for glaucoma:
This surgery is performed on patients to correct the anatomical structure of patients with narrow angles or on patients who already suffer from narrow angle or angle closure glaucoma. During this procedure, the laser makes a tiny hole in the iris, increasing the angle between the iris and the cornea and allowing fluid to drain. Laser iridotomy has a high rate of success and either prevents or cures angle closure glaucoma in almost all patients on whom it is performed. This is important because angle closure glaucoma involves high eye pressure, pain and even loss of vision.
Endocyclophotocoagulation, or ECP, is a surgical technique to reduce the amount of fluid, or aqueous humor, that is produced in the eye. ECP will lower the intraocular pressure, or IOP, within the eye, by directing a laser to the ciliary processes to slow down the production of fluid. Patients with medically controlled and uncontrolled glaucoma, a disease where excess fluid puts pressure on the optic nerve and damages vision, will benefit from this procedure. ECP is used as a last resort for glaucoma treatment.
The ECP Procedure
The surgeon will insert a tiny endoscopic camera with a fiber optic light at the tip into the ciliary processes, the part of the eye that produces fluid. Laser energy will be applied to the ciliary body to destroy some of these cells to stop the production of fluid. The result is a lower, healthier pressure within the eye. Many patients who undergo ECP reduce or eliminate their need for eye drops or other glaucoma medications after treatment.
ECP may be performed at the same time as phacoemulsification or, cataract surgery, for patients who are diagnosed with both cataracts and glaucoma. Recent studies have shown that patients who undergo the combined ECP/phacoemulsification procedure need fewer glaucoma medications over the long term.
Glaucoma Surgical Procedures
Trabeculectomy- creates a new drainage passage in the sclera, the white part of the eye, resulting in a new opening that allows the fluid to drain and enter the bloodstream.
Glaucoma drainage implant - a thin, flexible tube, known as a shunt, is inserted into the eye to facilitate drainage.
Peripheral Iridectomy - removes a small section of the iris to allow for drainage.
Trabeculotomy - is used in the treatment of congenital glaucoma. An incision is made into the outer portion of the eye to the trabecula, allowing for the drainage of fluid from the eye.
Glaucoma Drainage Devices - an artificial drainage shunt is a small device that is surgically placed in the eye to create a communication between the anterior chamber and sub-Tenon space. This is done by a surgeon trained in their use. The surgery may be done alone or in conjunction with cataract surgery.