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Glaucoma Surgery

Glaucoma refers to a medical condition in which the optic nerves lose retinal cells over time.  This can lead to visual complications, including blindness.  Glaucoma surgery is not always the first course of action that doctors employ to treat the condition.  Medications can be quite effective in controlling intra-ocular pressure and regulating glaucoma symptoms, thus preventing further loss of vision and resultant blindness.

Doctors employ glaucoma surgery to maintain the health of optic nerves and reduce intra-ocular pressure either by opening blocked drainage angles or creating new openings for the aqueous humor to leave the eyes. 

Glaucoma surgery can be performed via laser surgery or via more traditional open surgery.  When medicines are not effective in lowering intra-ocular pressure, doctors usually opt for laser surgery first (if they can).  This is followed by open surgery if more conventional methods are unsuccessful. 

There are a few approaches to glaucoma surgery, and each one depends on the condition of the patient:

Surgery to increase fluid drainage:  performed either as laser or open surgery, the procedure involves creating a trapdoor that drains fluid from the eye.  This can be done in a number of ways, including through: trabeculectomy — in which a piece of eye tissue is removed to allow fluid drainage; seton glaucoma surgery aka tube-shunt surgery — in which a tube is placed in the eye so that fluid might drain; laser trabeculoplasty — during which laser beams are used to burn tissue, creating an opening through which fluid drains; and laser sclerostomy – during which a piece of the white part of the eye is removed to create space for fluid to drain.

Both laser and open procedures are practised for the second kind of glaucoma surgery, i.e., surgery to prevent closure of drainage angle.  During this procedure, the doctor creates a new opening in the iris to allow fluid to drain out.  Laser surgery, called laser, iridectomy is performed in less complicated cases, while complex cases might need open surgery (surgical iridectomy). 

In some patients, surgery might not be successful in improving the flow of ocular fluid, and thus, an additional operation is performed to destroy the fluid creating organ, the ciliary body.  This procedure is the third kind of glaucoma surgery.  During laser cyclophotocoagulation, a laser is used to destroy the ciliary body.  When doctors use a freezing probe to perform the same task, the procedure is termed cyclocryotherapy.