Dr. ROLAND SEIF
Dr. ROLAND SEIF
Ophthalmologist in Beirut
 

What is Glaucoma ?

 

Glaucoma is a disease that damages your eye’s optic nerve, and is often associated with elevated pressure inside the eye. It is usually caused by fluid buildup inside the eye that leads to elevated pressure. It is a leading cause of irreversible blindness worldwide. Glaucoma causes no changes in vision usually until the damage is severe since it slowly and progressively affects the peripheral vision that is difficult to notice.

Glaucoma treatment involves increasing fluid outflow or decreasing production, resulting in the lowering of the intraocular pressure (IOP) to help prevent damage to the optic nerve. The three main types of treatment to lower the IOP are medical therapy, laser treatment, and surgery. The choice of treatment depends on several factors including the patient’s optic nerve condition, pressure inside the eye and level of damage.

 
 
 

Medication

Medical treatment consists mainly of drugs that are delivered to the eye by drops. Used every day, these eye drops lower eye pressure. Some do this by reducing the amount of aqueous fluid the eye makes. Others reduce pressure by helping fluid flow better through the drainage angle. Eye drops have the advantage of delivering the highest possible dose of medication directly to the eye while minimizing any side effects to the rest of the body.

 
 
 

Laser Treatment

Lasers are used frequently for glaucoma treatment, with common types including the Selective Laser Trabeculoplasty (SLT), Laser Peripheral Iridotomy (LPI), and Trans-Scleral Cyclophotocoagulation Diode Laser (TSCPC). They all work through either improving outflow of fluid or decreasing the amount of fluid produced. Some patients have laser treatment as their primary method of controlling their glaucoma while others have this done in combination with eye drops. Laser treatment is performed in the office or the minor operating room and generally allows a rapid return to normal daily activities.  

Selective Laser Trabeculoplasty (SLT) is an in-office procedure that opens the trabecular meshwork by targeting specific pigment cells of the eye. It produces a change in the trabecular meshwork without producing clinically observable scarring or other harm to the tissue. This procedure is particularly effective in patients with early to mild glaucoma.

Laser Peripheral Iridotomy (LPI) is also typically completed in the office. A laser is used to create a small opening at the outer edge of the iris. This allows the fluid to move more freely between the chambers of the eye and prevents a sudden buildup in pressure.

Diode Laser (TSCPC) is used to shrink the fluid-producing glands within the eye to reduce eye pressure. The most common version is a probe placed on the surface of the eye. It is quick procedure done without cutting into the eye and is usually performed in patients with advanced glaucoma or those who have undergone multiple eye surgeries.

 
 

Surgical Treatment

Surgery for glaucoma is performed in the operating room and is done to increase aqueous fluid outflow and lower eye pressure when medical or laser treatment has not adequately controlled a patient's pressures although sometimes it can be done as a primary treatment. Common procedures include traditional surgery such as trabeculectomy and glaucoma drainage devices (tube shunts) as well as a group of newer, less invasive surgeries collectively known as Minimally Invasive Glaucoma Surgery or MIGS. These are a group of procedures designed to lower intraocular pressure with a less invasive approach than traditional surgeries.

TRADITIONAL SURGERIES

These are the conventional surgeries that have been used for decades to significantly lower eye pressure in patients whose vision and quality of life are threatened by glaucoma.

A small opening is made in the wall of the eye to create a communication from inside the eye to the surface of the eye, and fluid tracking through this connection pools into a bubble hidden underneath the upper eyelid. This bubble of fluid is called a bleb. Aqueous humor will be able to drain out of the eye and into the bleb .

Like trabeculectomy, this surgery creates a communication from inside the eye to a reservoir of fluid on the surface of the eye. However, a device with a small silicone tube is used to create the communication. It is usually performed in patients who have failed previous surgeries, or patients with specific types of glaucoma.

Minimally Invasive Glaucoma Surgery (MIGS)

Minimally Invasive Glaucoma Surgery have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries. MIGS procedures work by using microscopic-sized equipment and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety.

Metallic microstents help fluid in the eye bypass the trabecular meshwork, the “point of greatest resistance” to fluid exiting the eye, and enter the canal of Schlemm to lower the eye pressure.They are permanent and not able to be felt by the patient. They are often used at the time of cataract surgery.

This procedure uses a tiny microstent to shunt fluid from inside the eye to the outer surface of the eye. It is a hybrid of the conventional glaucoma surgeries because it creates a reservoir of fluid (bleb) on the eye surface via a small polymer microshunt, but it theoretically carries less risk than either conventional procedure.

This technique involves the use of a disposable surgical blade that facilitates removal of a segment of the trabecular meshwork. This tissue functions like the strainer placed over the drain and it is often the “point of greatest resistance” to fluid leaving the eye. It is often done at the time of cataract surgery.

The goal of this surgery is to optimize the eye’s natural drainage pathways. This procedure uses a probe to extrudes a clear gel substance to dilate and break adhesions within Schlemm's canal. This procedure can be done from within the eye or from outside of the eye, and it is often done at the time of cataract surgery.