Surgery for glaucoma: description of the procedure, consequences and features

2024 Author: Curtis Blomfield | [email protected]. Last modified: 2023-12-16 20:44

Glaucoma is an insidious disease. Often it proceeds imperceptibly for the person himself, and begins to manifest itself when irreversible changes in the field of vision have already occurred. What does she represent? This is the general name for eye diseases that occur as a result of high intraocular pressure and develop over a long period of time. Due to pressure and in the absence of proper treatment, atrophy of the optic nerve and a decrease in visual acuity develop. In especially severe cases of glaucoma, surgery becomes the only solution to the problem.

Classification

Glaucoma is diagnosed congenital and acquired. The first is quite rare and is usually successfully operated on in infancy.

Acquired glaucoma is classified by cause:

1. Age - manifests itself most often after 40 years, until the moment of its occurrence, the patient's eyes may not be disturbed at all.
2. Secondary glaucoma is a consequence of the transfer of concomitantdiseases. This may be an injury to the eyes and ocular vessels, diabetes mellitus, atherosclerosis, hypertension. In any case, this concomitant disease causes increased intraocular pressure.
3. Open-angle - has the widest distribution among all recorded cases. The iridocorneal angle remains open, the drainage system of the eye is disturbed due to the reduction (and later disappearance) of the gaps between the trabeculae of the pectinate ligament. The fluid accumulates and creates gradually increasing pressure in the eye. Over time, the pressure can destroy the optic nerve.
4. Closed-angle - with this type of glaucoma, the iris-corneal angle is blocked by the root of the iris. This is due to the anatomical feature of the structure of the eye, in which the intraocular fluid flows poorly from the posterior chamber to the anterior one. Fluid accumulates, bulging the iris, and under adverse conditions, the pressure in the eye rises sharply.

Symptoms

Acquired glaucoma is dangerous because in the early stages of the disease it can be completely asymptomatic. In some cases, rainbow glare may occur before the eyes, which is a consequence of high intraocular pressure. In the future, the symptoms begin to manifest more clearly. The patient may experience:

1. Fatigue during visual stress.
2. Narrowing the view of vision, in particular, lateral and at an angle.
3. Deterioration of vision.
4. Poor adaptation when moving from a lit place toa room without lighting.
5. Impaired color perception.
6. The appearance of "blind spots" that interfere with the review. These spots grow over time.
7. With angle-closure glaucoma, acute pain and redness in the eye, headache attacks are likely.

Diagnosis

If a person notices one of several symptoms of glaucoma, he should immediately contact an ophthalmologist. Only a doctor will be able to reliably diagnose, since the symptoms of glaucoma are in many ways similar to other eye diseases.

Oculists use the following types of diagnosis and disease detection:

Standard vision test. It cannot confirm the diagnosis, but provides a basis for further research

1. Intraocular pressure measurement. This is a mandatory procedure for the likelihood of glaucoma, since it is pressure that affects the development of this disease. Before the examination, the eyes are anesthetized with special drops.
2. Gonioscopy. Allows you to view the anterior chamber of the eye. The examination is carried out using a special system of mirrors and a special microscope with built-in lighting. This examination helps the doctor see the angle between the cornea and the iris and determine what type of glaucoma the patient has.
3. Ophthalmoscopy. Performed with an ophthalmoscope. This instrument has a significant magnification that allows you to see the internal structure of the eye and identify damage to the optic nerve.
4. Perimetry. A special test that determines the presence and localization of "darkspots" on the pupil, indicate the boundaries of the field of view. Each eye is tested separately. The device gives signals in the form of flashing dots, the patient independently presses the button when his gaze fixes them.
5. Pachymetry. Helps to measure the thickness of the cornea of the eye. Knowing this parameter affects the accuracy of intraocular pressure measurement. If the cornea is thick, then the pressure will actually be lower than what the tonometry examination shows. And if the cornea is very thin, the true intraocular pressure will be higher than the measurement showed.
6. Scanning laser polarimetry. Measures the thickness of nerve fibers. A decrease in thickness indicates the death of nerve endings, which happens with glaucoma at an already advanced stage.

Treatments

As mentioned above, the symptoms of this disease at the initial stage are difficult for the patient to notice. It is for this reason that everyone, without exception, is recommended to visit an ophthalmologist's office once a year. If he manages to notice the disease at the initial stage, the treatment is likely to be conservative. In a neglected case, eye surgery is prescribed for glaucoma. Nerve damage and loss of vision for this reason can no longer be restored, but effective methods of treatment can slow down or stop the development of the disease.

1. Drug treatment.
2. Surgery.
3. Laser surgery.

Medicated treatment

At primaryFor open-angle glaucoma, conservative treatment is most often prescribed, since its result in this case will not be lower than the effectiveness of surgery for glaucoma. The primary goal of therapy is to reduce pressure in the eyes and improve aqueous humor drainage. Therefore, all medicines will be focused on this goal.

Drops are the most popular dosage form for eye treatment. To lower intraocular pressure, antiglaucoma drugs are prescribed. It is possible to combine these drops together with drugs aimed at improving the blood supply to the posterior part of the eyeball.

In some cases, the doctor may prescribe pills that improve the nutrition of the optic nerve and retina. Sometimes they can give a positive result and stop the progression of the disease, but the patient will have to adhere to conservative treatment for life so that the disease does not progress.

Surgical treatment

If treatment with pills and drops does not work, the doctor will prescribe one of the types of operations for glaucoma.

1. Trabeculectomy. In this operation, a small section of the trabecular meshwork and adjacent structures of the eye is removed, creating a valve and opening the way for the passage of moisture from the eye under the conjunctiva. A filter pad is created under the conjunctiva, the eye fluid will collect there, passing through the valve, and from there it will be absorbed by the blood vessels. As a result of the outflow of aqueous humor, the pressure on the eye will be reduced by 3cases from 4.
2. Peripheral iridectomy. The essence of the procedure is to remove a small area of the iris, which allows the intraocular fluid to gain access to the draining system of the eye. Free circulation of moisture reduces eye pressure.
3. Bypass surgery. If the use of the above operations for glaucoma is impossible for some reason, such a method of surgical intervention as shunting is prescribed. A shunt is inserted into the eye using a micro-incision. With each increase in pressure, it will transfer moisture to the sub-Tenon space, and from there it will be distributed into the bloodstream.
4. Implantation of drains - is used if conservative treatment has failed, and surgery for glaucoma has also helped. How does this happen? A drainage tube is placed in the anterior chamber of the eye and the flattened portion is inserted below the conjunctiva, allowing fluid to drain from the eye, forming a bubble.

Surgery with a laser

Today, doctors perform the following types of laser surgery for glaucoma:

1. Trabeculoplasty. In the treatment of open-angle glaucoma, an argon laser can be used. At the same time, unlike surgical trabeculoplasty, the laser does not create additional channels for the outflow of fluid, but stimulates the outflow itself. Unfortunately, this procedure does not give a permanent result, after a few years the patient has to resort to surgical treatment again.
2. Iridotomy. The laser makes a small hole in the iris of the eye, thereby improving the outflow of aqueous humor and equalizing the pressure between the front and back of the iris.

When an operation is scheduled for glaucoma, the medical professional weighs the pros and cons, studying the patient's medical history. Only after that he decides which procedure is suitable for a particular patient.

Surgery for glaucoma: when and why

Surgical intervention looks like a more radical and effective measure in the fight against such a disease as glaucoma. But it is not always worth resorting to it. The operation is really necessary in the following cases:

• Innate form. Diseases are treated by surgery, since in this case glaucoma is due to the peculiarities of the structure of the eye. Conservative treatment will not fix this problem.
• The use of some eye drops to reduce pressure is accompanied by a gradual violation of the production of intraocular fluid. Without bringing any positive result, the drops will worsen the condition of the organs of vision.
• In severe cases of glaucoma, surgery becomes mandatory if medical treatment fails.

Laser or surgery?

When drastic measures are needed to prevent vision loss, the patient and the doctor no longer think about whether to undergo surgery for glaucoma. In such cases, the more important question is which method to choose to solve the problem. Both laser andclassical surgical operations are performed to improve the outflow of moisture in the eye. This should lower intraocular pressure. Today, laser surgery for glaucoma is gaining more and more popularity. They have great technical capabilities to correct the pathologies of the visual organ. At the same time, the price of the laser surgery service is slightly higher than that which you have to pay for the operation in the classical way. For these reasons, "knifeless" eye surgery for glaucoma has become so popular.

Pros and cons of glaucoma surgery

Pros of treatment:

1. The laser beam allows you to correct visual defects without violating the integrity of the membranes and walls of the eye.
2. Short recovery time.
3. Painless procedure.
4. After the operation, aqueous humor will drain naturally.
5. Small percentage of possible complications.
6. The patient does not need to go to the hospital for inpatient treatment.
7. Affordable price.

Cons of laser surgery:

1. Reducing the pressure in the eye has a temporary effect.
2. Probability of a rapid increase in eye pressure during surgery.
3. During the process, there is a risk of injury to the vessels of the iris, corneal epithelial cells and lens capsule.
4. Possible appearance of cicatricial adhesions in the area of operation.

Complications after surgery

In most cases, in the treatment of glaucoma, the operation does not give complications, but to exclude the possibilitythis is completely impossible.

Surgical operations on the eyes may cause:

1. Increased sensitivity to light for 6 months after the procedure.
2. Decrease in visual acuity.
3. Need for reoperation.
4. Inflammatory processes in the eyes.
5. Reducing the transparency of the cornea.
6. Development of concomitant cataract disease.
7. Bacterial contamination.

In the treatment of glaucoma, the consequences after surgery with a laser beam:

1. Bleeding in the anterior chamber, eyelids and orbit. Although it looks intimidating, it is not particularly dangerous.
2. Cramps and burning in the eyes when using local anesthesia.

Despite the impressive success of eye surgery, if the optic nerve is already damaged in glaucoma, the surgeon will not be able to restore full vision. For this reason, experts recommend not neglecting the he alth of the eyes, regularly undergo ophthalmological examinations. If you follow this advice, you can avoid loss of vision or its significant deterioration.