Glaucoma is a severe eye disease that can lead to complete loss of vision. At an early stage of pathology, doctors use conservative therapy. However, this does not always give the desired effect. In such difficult cases, it is necessary to resort to surgical treatment of glaucoma. This is often the only way to prevent blindness. In the article, we will consider in detail the main types of operations, the methodology for their implementation and the features of the rehabilitation period.
Description of pathology
The term "glaucoma" in ophthalmology refers to a group of diseases that are accompanied by high intraocular pressure, blurred vision and atrophic changes in the optic nerve. Such pathologies are more common in older people, but the occurrence of the disease at a young age cannot be ruled out.
The chambers of the eye are constantly producing fluid. If its outflow is disturbed, then the patient increases the pressure inside the organ of vision. This compresses the optic nerves. A person's vision deteriorates. This disorder is called glaucoma by ophthalmologists. The following forms of pathology are distinguished:
- open-angle;
- closed angle.
These two varieties of the disease differ in the mechanism of violation of the outflow of fluid from the eye chambers. Angle-closure glaucoma is considered a more severe form of pathology.
With glaucoma, doctors prescribe drops to patients to reduce pressure inside the eye, as well as drugs to improve blood circulation and metabolism in the organ of vision. These medicines have to be used constantly. If medications do not work, then patients are shown vision correction with a laser.
However, drug therapy does not always lead to the desired result. In this case, surgical treatment of glaucoma is indicated. When choosing a method of operation, the form and stage of the pathology are taken into account.
When surgery is needed
Should I have eye surgery? This question often worries patients. Surgery is necessary if the patient has the following indications for surgical treatment of glaucoma:
- No effect from the use of drops. If, after a course of drug therapy, the patient has high intraocular pressure, then his condition can only be improved with the help of surgery.
- Narrowing marginsvision. This is a sign of damage to the optic nerve. In such cases, the only way to save the patient's vision is through surgery.
- Failure to follow the instructions of the ophthalmologist. The operation is also indicated if patients, due to old age or for some other reason, cannot instill drugs into the eye on their own.
Often, patients themselves express a desire to be treated surgically. Thus, they want to get rid of the need for constant use of drops, which have many side effects. In such cases, only an ophthalmologist can assess the need for surgery.
Usually glaucoma is chronic. But sometimes there is an acute form of the disease, in which blindness can occur within a few days. With such a rapid development of the pathology, the patient needs an emergency operation.
Varieties of operations
Currently, the following types of surgical treatment of glaucoma are used in ophthalmology:
- iridectomy;
- trabeculectomy;
- drainage;
- cyclodialysis;
- sclerectomy.
Which of the following operations is the most efficient? This question is difficult to answer. After all, each type of surgical intervention has its indications. Here, much depends on the form of pathology, the danger of loss of vision and the general condition of the patient. Only a specialist can evaluate all these factors.
Next, we will consider in detail the main types of surgical treatment of glaucoma and the consequences of operations.
Preparatory period
A patient with an acute form of the disease and progressive blindness is operated on an emergency basis. In this case, there is no time left to prepare for the intervention. The main task of doctors is to urgently restore the outflow of fluid from the eye chambers and save vision.
In the chronic form of the disease, the operation is carried out in a planned manner. The following preparation is needed for the surgical treatment of glaucoma.
- Before the operation, the patient undergoes a comprehensive diagnosis. The fields and visual acuity are examined, the pressure inside the eye is measured several times. The patient is also prescribed laboratory tests.
- One week before surgery, the patient should stop using drops for increased intraocular pressure. Otherwise, surgery will not give the desired result. It is also forbidden to take drugs for blood thinning. Only antibacterial eye drops are allowed.
- Food must be avoided on the day of the operation.
Surgical treatment of glaucoma in the elderly has its own characteristics. A week before surgery, such patients are prescribed sedatives. This ensures sound sleep and a calm psychological state before the intervention.
Surgical treatments for glaucoma are used only in inpatient settings. The patient is admitted to the hospital the day before the operation. The length of stay in the hospital depends on the type of intervention and the characteristics of the course of the rehabilitation period.
Iridectomy
ThisSurgical treatment of glaucoma is used in angle-closure form of pathology. The operation is performed on the iris. It is in this area that fluid passes from the posterior chamber of the eye to the anterior one.
If the angle of the anterior chamber is closed, then the outflow of moisture is disturbed, and intraocular pressure increases. This is noted in the closed-angle form of pathology. An iridectomy allows you to open or widen the angle of the anterior chamber.
This operation does not require general anesthesia, it is performed under local anesthesia. The surgeon cuts the conjunctiva, removes a section of the sclera and opens the anterior eye chamber. Then the doctor removes a small section of the iris and stitches it. This opens the chamber angle and restores normal fluid outflow.
If it is necessary to expand the camera angle, then the operation is carried out in a slightly different way. The doctor using a spatula separates the ciliary body. This leads to the expansion of the closed angle and the normalization of moisture removal. The anterior eye chamber is then filled with air and sutured.
Sutures are removed after 7-10 days with any method of iridectomy.
Trabeculectomy
This is the most common surgical treatment for glaucoma. It is recommended for patients whose own drainage system of the eye is very weak. During surgery, passages are created to drain fluid (fistulas).
The doctor injects the patient with a local anesthetic and makes an incision in the conjunctiva and sclera. Then the doctor excised the trabeculae (part of the drainagesystem of the eye) and eliminates the obstacle to the removal of moisture. In some cases, an iridectomy is performed at the same time.
After creating a fistula, the patient is given drops to dilate the pupil. This causes temporary visual impairment, but is necessary to control the condition of the eye.
Such a surgical treatment of glaucoma has its advantages and disadvantages. In 85% of cases, the patient returns to normal intraocular pressure. However, in a small proportion of patients, the created channel undergoes cicatricial changes over time. It is no longer possible to restore its patency surgically. Also, the consequence of the operation may be a malnutrition of the lens and the development of cataracts.
Drainage
This operation is performed when the creation of a fistula is ineffective. Tubes are placed in the eye chamber to drain fluid. In some cases, special valves are introduced that open when the pressure rises.
Drainage operations help even in advanced cases. In this case, there is no risk of developing cicatricial changes. Today, pipes and valves are made from modern high-quality materials. Drainage devices do not overgrow and maintain patency for a long time.
Cyclodialysis
This operation is indicated for patients with uncomplicated pathology. Using a spatula, the surgeon peels off a part of the vascular tissue from the sclera. This creates a channel for moisture removal.
After the operation may occurhemorrhage in the anterior chamber of the eye. However, it resolves on its own and does not pose a risk to the patient's he alth.
Sclerectomy
This type of glaucoma surgery is rarely used. During the operation, the doctor removes part of the outer eye membrane. Intervention is indicated for open-angle pathology.
However, after sclerectomy, patients often develop fibrotic changes in the eye tissues. Therefore, it is necessary to do repeated operations very often. There are more effective and safer types of surgery these days.
Consequences
In some cases, there are postoperative complications. Therefore, careful monitoring of the patient after surgical treatment of glaucoma is necessary. The consequences of the operation may be the following pathologies:
- choroid detachment;
- excessive decrease in pressure inside the eye;
- scarring and overgrowth of the fistula;
- inflammatory processes in the structures of the organ of vision;
- bleeding into the anterior chamber.
These complications are treatable. Timely diagnosis of emerging pathologies is of great importance. Most often, the negative consequences of operations are noted in people over the age of 75.
Rehab
After the operation, the patient is in the hospital under the supervision of a doctor, and after being discharged, he regularly comes for examinations to the ophthalmologist.
In the postoperative period, you must adhere to the following rules:
- Close for a few daysoperated eye with bandage.
- The first week after the intervention, avoid eye strain, stop watching TV and working at the computer.
- For 10 days, keep your eyes out of water and do not shower.
- Keep a gentle regime and do not expose yourself to physical activity.
- Wear sunglasses in bright light.
- After surgery, it is strictly forbidden to drink alcohol and s alty foods.
After surgery, doctors prescribe eye drops with antibiotics and corticosteroids. This helps prevent inflammatory complications. You must carefully adhere to the prescribed treatment regimen.
Forecast
How effective is glaucoma treatment with surgery? After surgery, 90% of patients are in remission. Intraocular pressure returns to normal. This effect persists for 5-6 years. If the patient has had artificial drainage installed, then the pressure is kept within the normal range for about 2 years. After the end of this period, repeated surgical treatment is required.
However, even after high-quality surgery, new obstacles to the removal of fluid may form. It is not yet possible to avoid such consequences of glaucoma. In addition, in elderly patients, high pressure inside the eye can be combined with cataracts. In this case, not only the surgical treatment of glaucoma is necessary, but also the replacement of the lens.
If a patient has partially lost sight due to glaucoma, then it is already possible to restore itit is forbidden. After all, with this disease, photosensitive cells die, and this is an irreversible process. The operation only helps to stop the pathology and prevent further deterioration of vision.
Where operations are performed
Surgical treatment of glaucoma in Moscow is carried out in the ophthalmological departments of hospitals or specialized eye hospitals. For citizens of Russia, free operations are possible under the CHI policy. To do this, you must have a referral from the attending ophthalmologist, as well as the results of laboratory tests and instrumental examinations. Planned operations are carried out according to the quota, that is, in the order of priority.
In acute form of glaucoma, the patient needs urgent surgery. Delay threatens him with loss of sight. In such cases, the ambulance team takes the patient to the hospital. Surgery is carried out on an emergency basis.
Surgical treatment of glaucoma in Moscow is also carried out in private clinics. The cost of the operation may vary. On average, the cost of surgical treatment ranges from 20,000 to 45,000 rubles. The most expensive type of operation is the installation of drainage with a reservoir for the outflow of moisture.
Patient feedback
You can find a lot of positive reviews about the surgical treatment of glaucoma. After the operations, intraocular pressure in patients returned to normal, pain in the sclera and the vision of rainbow circles in the field of vision disappeared. Patients note that their eyes are much less tired. Most of the patients stopped visual impairment.
Judging by the reviews, operationsare almost painless. During surgery, powerful local anesthetics are used. A slight discomfort occurs in the postoperative period, but discomfort is quickly stopped by special drops.
Negative reviews are mainly due to the fact that the operation did not help patients regain their lost vision. It is important to remember here that with glaucoma there is an irreversible damage to the internal structures of the eye. Therefore, it is no longer possible to restore vision. Surgical treatment only helps to stop further damage to the optic nerve.
Ophthalmic surgery for glaucoma has its advantages and disadvantages. They effectively reduce intraocular pressure and help to avoid blindness. However, surgical interventions lead only to a temporary remission. They need to be repeated every few years.
