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Management
Surgical Treatment
(Trabeculectomy) When both medical and laser treatment are not effective, incisional glaucoma surgery may be considered. Surgery for glaucoma involves making an entirely new drainage system for the eye. The most common type of surgery for glaucoma is called trabeculectomy. Trabeculectomy is the same as "filtering surgery," an older term. The surgery involves creating a new fluid drain through the wall of the eye, usually where the white meets the coloured part.
After surgery, the eye fluid drains through the newly created passage to a reservoir, known as a filtering bleb, which is created during surgery from the normal covering of the eye. This bleb appears as a blister-like bump on the white of the eye, usually under the upper eyelid (Figure 3). It is desirable to obtain a well-functioning bleb.
The surgeon examines the appearance and function of the bleb carefully during the weeks and months following surgery. The new draining system bypasses the blocked natural drain, the trabecular meshwork. The blisterlike reservoir, which collects the fluid, is not directly open to the outside. Instead, the fluid which is drained from the eye is reabsorbed by the body. In certain cases, the ophthalmologist may elect to use a drainage tube to direct the fluid from the front chamber of the eye.
Glaucoma filtering surgery can result in an eye pressure which is very low. Eye drops often are no longer needed after the initial healing process is completed. More than three-quarters of the patients undergoing this type of surgery have their eye pressure adequately controlled afterwards. Infrequently, pressure-lowering medications may be needed after surgery to control the intraocular pressure.
The disadvantages of surgery must also be considered. Although the success rate is quite good, some patients are still not controlled effectively. This means that they will need further medication or surgery. The eye which has undergone glaucoma filtering surgery will always be susceptible to infection which can lead to loss of vision. There is also the associated discomfort of any surgical procedure. Further, immediately following surgery, there are physical activity limitations and the eye may be irritated.
Surgery for glaucoma involves making an entirely new drainage system for the eye. The most common type of surgery for glaucoma is called trabeculectomy.
Once a surgical procedure is completed it cannot be undone, although it can be repeated or revised at a later time, if needed. The new drainage system is not a natural part of the eye, and it can be a source of discomfort or even pain. Vision is often blurred for several weeks after glaucoma surgery, but usually returns to, or near, the level present before surgery within three months.Vision does not always return to this earlier level because of worsening of cataracts or otherpossible complications associated with the surgery.
(Trabeculectomy) When both medical and laser treatment are not effective, incisional glaucoma surgery may be considered. Surgery for glaucoma involves making an entirely new drainage system for the eye. The most common type of surgery for glaucoma is called trabeculectomy. Trabeculectomy is the same as "filtering surgery," an older term. The surgery involves creating a new fluid drain through the wall of the eye, usually where the white meets the coloured part.
After surgery, the eye fluid drains through the newly created passage to a reservoir, known as a filtering bleb, which is created during surgery from the normal covering of the eye. This bleb appears as a blister-like bump on the white of the eye, usually under the upper eyelid (Figure 3). It is desirable to obtain a well-functioning bleb.
The surgeon examines the appearance and function of the bleb carefully during the weeks and months following surgery. The new draining system bypasses the blocked natural drain, the trabecular meshwork. The blisterlike reservoir, which collects the fluid, is not directly open to the outside. Instead, the fluid which is drained from the eye is reabsorbed by the body. In certain cases, the ophthalmologist may elect to use a drainage tube to direct the fluid from the front chamber of the eye.
Glaucoma filtering surgery can result in an eye pressure which is very low. Eye drops often are no longer needed after the initial healing process is completed. More than three-quarters of the patients undergoing this type of surgery have their eye pressure adequately controlled afterwards. Infrequently, pressure-lowering medications may be needed after surgery to control the intraocular pressure.
The disadvantages of surgery must also be considered. Although the success rate is quite good, some patients are still not controlled effectively. This means that they will need further medication or surgery. The eye which has undergone glaucoma filtering surgery will always be susceptible to infection which can lead to loss of vision. There is also the associated discomfort of any surgical procedure. Further, immediately following surgery, there are physical activity limitations and the eye may be irritated.
Surgery for glaucoma involves making an entirely new drainage system for the eye. The most common type of surgery for glaucoma is called trabeculectomy.
Once a surgical procedure is completed it cannot be undone, although it can be repeated or revised at a later time, if needed. The new drainage system is not a natural part of the eye, and it can be a source of discomfort or even pain. Vision is often blurred for several weeks after glaucoma surgery, but usually returns to, or near, the level present before surgery within three months.Vision does not always return to this earlier level because of worsening of cataracts or otherpossible complications associated with the surgery.