Glaucoma

Glaucoma is a condition where there is characteristic damage to the optic nerve at the back of the eye resulting in loss of visual fields.

It is a condition often related to high intraocular pressure although it can occur even if the eye pressures are normal.

Treatment of glaucoma involves lowering the intraocular pressure. Initial treatment often involves eye drops.
If medical therapy is insufficient other treatment options are available.

Laser Therapy

Laser is used to enhance the outflow system of the eye in order to lower intraocular pressure. Selective laser trabeculoplasty(SLT) is used in a clinic setting to enhance outflow through the natural drainage system. It is a pain free, quick procedure carried out as an outpatient which often produces an effective lowering of intraocular pressure. It can be used as first line therapy or as an adjunct to glaucoma eyedrops.

Angle surgery

There are now many surgical options in the treatment of glaucoma. Many of them focus on enhancing the outflow system through the natural drainage channels. The obstructions to the drainage system can be removed by means of an ab internal goniotomy using a Kahook dual blade(KDB). The resistance can also be bypassed by inserting a small titanium stent in the form of the Glaucos iStent or the Ivantis Hydrus stent. The internal drainage channel can also be dilated using a technique called ab internal canaloplasty(Abic). All of these procedures fall under the umbrella of minimally invasive glaucoma surgery(MIGS) with good effectiveness and a low risk profile. The reduction in intra ocular pressure is often sufficient for patients suffering from mild to moderate glaucoma.
These procedures can be performed on its own but more often are combined with cataract surgery to achieve the maximum pressure lowering effect.

Ciliary body treatment

The ciliary body is the structure that produces the fluid in the eye which maintains the pressure. In glaucoma patients the pressure is normally raised due to obstructed outflow. One can tackle the high pressure by reducing the production of fluid, similar to turning down the tap on a bath that is overfilling.

Ciliary body treatment is often reserved for glaucoma in the later stages and more complicated glaucoma. It can be performed using the traditional continuous wave style laser or the latest micro pulse diode laser.

Both types of laser have been shown to be effective in pressure lowering with the micro pulse laser offering a slightly better safety profile.

Filtration surgery

Often when a significant pressure lowering is required (for example in moderate to severe glaucoma) one would require a filtration operation. Filtration surgery works by creating an extra outflow channel in the eye allowing the fluid to escape to the subconjunctival space. The Preserflo Microshunt and Xen Gel stent are both innovative micro devices that can be inserted into the eye to allow the fluid to do escape. It is a quick 10 to 20 minute procedure which achieves a significant pressure lowering effect with minimal complication.

Trabeculectomy

Trabeculectomy has been the gold standard in glaucoma drainage operations for many years. It remains one of the most powerful glaucoma operations in terms of pressure lowering and percentage of success. It is particularly useful in patients with more advanced disease where a low target pressure is required and subsequent use of glaucoma drops is deemed to be undesirable. In a trabeculectomy a drainage channel is created at the top of the eye under a scleral flap. The flap is then secured using very fine sutures. During the post-operative visits one can remove these sutures to gradually open the drainage flap and titrate the pressure down to the target level. Surgery takes 30-45 minutes and is usually performed under local anaesthetic. Post operatively patients are monitored initially on a weekly basis in order to adjust the pressure down to the desired target.

Tube surgery

Glaucoma tube surgery is designed to combat the more complicated types of glaucoma. It is often used when previous glaucoma surgery has failed. Baerveldt tube and Ahmed valves are the two traditional devices designed to shunt fluid from inside the eye to the subconjunctival space. We now offer the newer Paul glaucoma implant and the Eyewatch glaucoma implant, both with improved technology which significantly enhances success and safety.

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