Glaucoma Laser Surgery .

If you’ve been diagnosed with glaucoma and have been been thinking about getting laser surgery as a treatment and are wondering what the procedure for glaucoma laser surgery is, I’ll explain in this article how it’s done.

Laser surgery is used to help control glaucoma. If you’re using glaucoma medicines now, either eye drops or oral medications, you may be suffering from the side effects of these drugs. Some of the side effects you may not be aware of. You may want to get off these medicines but are concerned about the buildup of pressure in your eyes.
Surgical Procedures

When medications do not achieve the desired results, or have intolerable side effects, your ophthalmologist may suggest surgery.

Laser SurgeryLaser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery though the long-term success rates are variable. The most common type performed for open-angle glaucoma is called trabeculoplasty. This procedure takes between 10 and 15 minutes, is painless, and can be performed in either a doctor's office or an outpatient facility. The laser beam (a high energy light beam) is focused upon the eye's drain. Contrary to what many people think, the laser does not bum a hole through the eye. Instead, the eye's drainage system is changed in very subtle ways so that aqueous fluid is able to pass more easily out of the drain, thus lowering IOP.

You may go home and resume your normal activities following surgery. Your doctor will likely check your IOP one to two hours following laser surgery. After this procedure, many patients respond well enough to be able to avoid or delay surgery. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications. This, however, is not true in all cases. Your doctor is the best judge of determining whether or not you will still need medication. Complications from laser are minimal, which is why this procedure has become increasingly popular and some centers are recommending the use of laser before drops in some patients.

Argon Laser Trabeculoplasty (ALT) -- for open-angle glaucoma
The laser treats the trabecular meshwork of the eye, increasing the drainage outflow, thereby lowering the IOP. In many cases, medication will still be needed. Usually, half the trabecular meshwork is treated first. If necessary, the other half can be treated as a separate procedure. This method decreases the risk of increased pressure following surgery. Argon laser trabeculoplasty has successfully lowered eye pressure in up to 75 percent of patients treated. This type of laser can be performed only two to three times in each eye over a lifetime.

Selective Laser Trabeculoplasty (SLT) -- for open-angle glaucomaSLT is a newer laser that uses very low levels of energy. It is termed "selective" since it leaves portions of the trabecular meshwork intact. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated. Some authors have reported that a second repeat application of SLT or SLT after prior ALT is effective at lowering IOP.

Laser Peripheral Iridotomy (LPI) -- for angle-closure glaucomaThis procedure is used to make an opening through the iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This allows the fluid to bypass its normal route. LPI is the preferred method for managing a wide variety of angle-closure glaucomas that have some degree of pupillary blockage. This laser is most often used to treat an anatomically narrow angle and prevent angle-closure glaucoma attacks.

CycloablationTwo laser procedures for open-angle glaucoma involve reducing the amount of aqueous humor in the eye by destroying part of the ciliary body, which produces the fluid. These treatments are usually reserved for use in eyes that either have elevated IOP after having failed other more traditional treatments, including filtering surgery, or those in which filtering surgery is not possible or advisable due to the shape or other features of the eye. Transscleral cyclophotocoagulation uses a laser to direct energy through the outer sclera of the eye to reach and destroy portions of the ciliary processes, without causing damage to the overlying tissues. With endoscopic cyclophotocoagulation (ECP), the instrument is placed inside the eye through a surgical incision, so that the laser energy is applied directly to the ciliary body tissue.

Traditional Surgery
Trabeculectomy
When medications and laser therapies do not adequately lower eye pressure, doctors may recommend conventional surgery. The most common of these operations is called a trabeculectomy, which is used in both open-angle and closed-angle glaucomas. In this procedure, the surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball. A small bubble of fluid called a "bleb" often forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury. Many surgeons perform trabeculectomy with an anti-fibrotic agent that is placed on the eye during surgery and reduces such scarring during the healing period. The most common anti-fibrotic agent is Mitomycin-C. Another is 5-Fluorouracil, or 5-FU.

About 50 percent of patients no longer require glaucoma medications after surgery for a significant length of time. Thirty-five to 40 percent of those who still need medication have better control of their IOP. A trabeculectomy is usually an outpatient procedure. The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.

Drainage Implant SurgerySeveral different devices have been developed to aid the drainage of aqueous humor out of the anterior chamber and lower IOP. All of these drainage devices share a similar design which consists of a small silicone tube that extends into the anterior chamber of the eye. The tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is thought to lower IOP less than trabeculectomy but is preferred in patients whose IOP cannot be controlled with traditional surgery or who have previous scarring.

Nonpenetrating SurgeryNewer nonpenetrating glaucoma surgery, which does not enter the anterior chamber of the eye, shows great promise in minimizing postoperative complications and lowering the risk for infection. However, such surgery often requires a greater surgical acument and generally does not lower IOP as much as trabeculectomy. Furthermore, long term studies are needed to assess these procedures and to determine their role in the clinical management of glaucoma patients.

Some Promising Surgical Alternatives The ExPress mini glaucoma shunt is a stainless steel device that is inserted into the anterior chamber of the eye and placed under a scleral flap. It lowers IOP by diverting aqueous humor from the anterior chamber. The ExPress offers the glaucoma surgeon an alternative to either repeating a trabeculectomy or placing a more extensive silicone tube shunt in those patients whose IOP is higher than the optic nerve can tolerate.

The Trabectome is a new probe-like device that is inserted into the anterior chamber through the cornea. The procedure uses a small probe that opens the eye's drainage system through a tiny incision and delivers thermal energy to the trabecular meshwork, reducing resistance to outflow of aqueous humor and, as a result, lowering IOP.

Canaloplasty, a recent advancement in non-penetrating surgery, is designed to improve the aqueous circulation through the trabecular outflow process, thereby reducing IOP. Unlike traditional trabeculectomy, which creates a small hole in the eye to allow fluid to drain out, canaloplasty has been compared to an ocular version of angioplasty, in which the physician uses an extremely fine catheter to clear the drainage canal.

Glaucoma eye drops do have significant side effects and it’s best if you can stop taking them provided you have an alternative and that alternative may be laser surgery. Sometimes glaucoma medications don’t work.

Simply- glaucoma is an eye disease of which there are two basic kinds – primary open angle and acute angle-closure.

There is a clear fluid that flows though the passages of your eye. Sometimes these passages get blocked and the fluid will build up in the eye and cause too much pressure. This pressure can cause damage to the optic nerve and a loss of vision. The result is glaucoma.

Laser surgery uses a tiny but powerful light beam to help drain the fluid from your eye easier. The eye surgeon will make holes or use it to shrink the clogged areas in your eye. This surgery can help you decrease your eye pressure. The surgery may be done on one or both eye. It can affect one eye only.

The surgery is done in your doctors’ office or in a clinic. You should be able to see just fine after surgery except you may feel some grittiness in your eye or eyes. Your eye or eyes may be swollen too. But these symptoms will go away in a day or two. You may have some sensitivity to light and some blurred vision for three weeks or so while your eyes heal. You would still take your eye drops or oral medications during this time period.

Now this is the basic procedure is for glaucoma laser surgery. Your ophthalmologist can fill you in more fully as it applies to your individual eye problem.

It’s important to note that any lost vision won’t return. This surgery is meant to prevent future loss of vision and help you avoid taking lifetime medications that may be harmful to your body. Laser surgery may not be appropriate for all types of glaucoma but your eye surgeon or ophthalmologist will help determine that. In any case glaucoma laser surgery is a consideration and want to avoid eye drops and seek a better solution.