Glaucoma surgery: description of the procedure, consequences and features

Glaucoma is an insidious disease. Often it proceeds imperceptibly for the person himself, and begins to appear when irreversible changes in the field of vision have already occurred. What is she like? This is the common name for eye diseases that arise as a result of high intraocular pressure and develop over time. Due to pressure and in the absence of proper treatment, atrophy of the optic nerve and a decrease in visual acuity develops. In 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, as a rule, is successfully operated on in infancy.

Acquired glaucoma is classified due to the occurrence of:

1. Age - it manifests itself most often after 40 years, until the moment of its occurrence, the patient may not be disturbed by the eyes.
2. Secondary glaucoma is a consequence of the transfer of a concomitant disease. This can be an injury to the eyes and eye vessels, diabetes mellitus, atherosclerosis, hypertension. In any case, this concomitant disease causes increased intraocular pressure.
3. Open-angle - is the most widespread among all recorded cases. The iris-corneal angle remains open, the drainage system of the eye is impaired due to the reduction (and later disappearance) of the gaps between the trabeculae of the comb ligament. Fluid builds up and creates gradually increasing pressure in the eye. Over time, 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 eye structure, in which intraocular fluid flows poorly from the posterior chamber to the anterior one. The fluid accumulates, protruding the iris of the eye, 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, the appearance of rainbow glare in front of the eyes is possible, which is a consequence of high intraocular pressure. In the future, the symptoms begin to manifest more clearly. The patient may experience:

1. Fatigue at visual stress.
2. Narrowing the view, in particular from the side and at an angle.
3. Visual impairment.
4. Poor adaptation when moving from a lit place to a room devoid of lighting.
5. Impaired color perception.
6. The appearance of "blind spots" that interfere with the review. Over time, these spots grow.
7. With angle-closure glaucoma, acute pain and redness in the eye, headache attacks are likely.

Diagnostics

If a person notices one of several symptoms of glaucoma, he needs to contact an ophthalmologist immediately. Only a doctor can reliably make a diagnosis, since the symptoms of glaucoma are largely similar to other eye diseases.

Optometrists use the following types of diagnosis and detection of the disease:

1. Standard eye test. She cannot confirm the diagnosis, but provides the basis for further research.

1. Measurement of intraocular pressure. This is a mandatory procedure for the likelihood of glaucoma, since it is the pressure that affects the development of this disease. Before examination, the eyes are anesthetized with special drops.
2. Gonioscopy Allows you to inspect 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 establish what kind of glaucoma the patient has.
3. Ophthalmoscopy It is performed using an ophthalmoscope. This tool has a significant increase, which allows you to see the internal structure of the eye and detect damage to the optic nerve.
4. Perimetry. A special test, with the help of which the presence and localization of "dark spots" on the pupil is determined, indicate the boundaries of the field of view. Each eye is checked 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 measure the thickness of the cornea. Knowledge of this parameter affects the accuracy of measurement of intraocular pressure. If the cornea is thick, then the pressure will actually be lower than the tonometry examination shows. And if the cornea is very thin, the true intraocular pressure will be higher than the measurement result showed.
6. Scanning laser polarimetry. Measures the thickness of nerve fibers. The decrease in thickness indicates the death of nerve endings, which happens with glaucoma at an already advanced stage.

Treatment methods

As mentioned above, the symptoms of this disease at the initial stage are difficult to notice for the patient. For this reason, without exception, everyone is recommended to visit the 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 the advanced case, an eye operation is prescribed for glaucoma. For this reason, nerve damage and loss of vision cannot be restored, but effective methods of treatment can slow down or stop the development of the disease.

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

Drug treatment

With primary 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 the flow of intraocular fluid. Therefore, all drugs will be focused precisely on this goal.

Drops are the most popular dosage form for treating the eyes. To reduce intraocular pressure, antiglaucoma agents are prescribed. It is possible to combine these drops with drugs aimed at improving blood supply to the posterior eyeball.

In some cases, the doctor may prescribe pills that improve 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 all his life so that the disease does not progress.

Surgical treatment

If treatment with tablets and drops does not give results, the doctor will prescribe one of the types of operations for glaucoma.

1. Trabeculectomy. During this operation, a small portion of the trabecular network and adjacent structures of the eye is removed, creating a valve and opening the way for moisture to pass from the eye under the conjunctival membrane. A filter pad is created under the conjunctiva, the eye fluid will be collected 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, eye pressure will be reduced in 3 out of 4 cases.
2. Peripheral iridectomy. The essence of the procedure is to remove a small area of ​​the iris, which allows intraocular fluid to access the drainage system of the eye. Free circulation of moisture reduces eye pressure.
3. Shunt surgery. If the use of the above operations for glaucoma is impossible for some reason, a method of surgical intervention such as shunting is prescribed. Using a micro incision, a shunt is inserted into the eye. With each increase in pressure, it will transfer moisture to the subtenon space, and from there it will be distributed into the bloodstream.
4. Drainage implantation — used if conservative treatment has been unsuccessful, 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 flow out of the eye, forming a bubble.

Laser Surgery

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

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

When surgery is prescribed for glaucoma, the medical professional weighs the pros and cons, and examines the patient’s medical history. Only after that he decides which procedure is suitable for a particular patient.

Glaucoma surgery: when and why

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

• Congenital form. Diseases are treated in an operational way, since in this case glaucoma is caused by structural features of the eye. Conservative treatment does not fix this problem.
• The use of some eye drops in order to reduce pressure is accompanied by a gradual disruption in the production of intraocular fluid. Without bringing any positive result, drops will worsen the state of the organs of vision.
• In severe cases of glaucoma, surgery becomes mandatory if drug treatment does not provide the necessary effectiveness.

Laser or surgery?

When radical measures are needed to prevent vision loss, the patient and the doctor no longer think about whether or not to perform surgery for glaucoma. In such cases, the more important question is which method to choose to solve the problem. Both laser and classic surgeries are performed to improve the outflow of moisture in the eye. This should lower intraocular pressure. Today, laser surgery for glaucoma is gaining increasing popularity. They have great technical capabilities to correct pathologies of the visual organ. At the same time, the price of a laser surgery service is slightly higher than that which you have to pay for the operation in the classical way. For these reasons, “legless” eye operations with glaucoma have become so in demand.

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 rehabilitation period.
3. Painless procedure.
4. After surgery, the outflow of intraocular fluid will occur in a natural way.
5. A small percentage of probable complications.
6. The patient does not need to go to hospital for inpatient treatment.
7. Affordable price.

Cons of laser surgery:

1. Reducing pressure in the eye has a temporary effect.
2. The likelihood of a rapid increase in pressure in the eyes 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 scar adhesions in the area of ​​operation.

Complications after surgery

In most cases, in the treatment of glaucoma, the operation does not give complications, but the probability of this cannot be completely ruled out.

During eye surgery, you may experience:

1. Hypersensitivity to light for 6 months after the procedure.
2. Visual acuity.
3. The need for reoperation.
4. Inflammatory processes in the eyes.
5. Decreased transparency of the cornea.
6. The development of concomitant cataract disease.
7. Bacterial infection.

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

1. Bleeding in the anterior ophthalmic chamber, eyelids and orbit. Despite the fact that it looks intimidating, it does not pose any particular danger.
2. Cramps and burning in the eyes when using local anesthesia.

Despite the spectacular successes of eye surgery, if the optic nerve is already affected by glaucoma, the surgeon will not be able to restore vision in full. For this reason, experts recommend that you do not neglect eye health, regularly undergo eye examinations. If you follow this advice, you can avoid loss of vision or its significant deterioration.