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Overview Of Glaucoma Surgery

Glaucoma  is a group of eye diseases that affecting to the optic nerve, and gradually result in loss of vision by permanently damaging the optic nerve, the nerve that transmits visual images to the brain.

Glaucoma is normally, but not always, related with elevated pressure in the eye (intraocular pressure (IOP)). Usually, this elevated eye pressure that leads to damage of the eye (optic) nerve. In few cases, glaucoma may occur in the presence of normal eye pressure. The glaucoma can cause by poor regulation of blood flow to the optic nerve.

Types of glaucoma: 

  • Open-angle glaucoma:  It’s often increases greatly with age and it is a chronic, not acute, disease.
  • Angle-closure glaucoma: its may be acute or chronic.  

Symptoms

  • Blurred vision or Hazy
  • Severe eye pain and headache
  • Nausea or vomiting (severe eye pain)
  • Reddening of the eye
  • The rainbow colored circles around bright lights will appear
  • Sudden sight loss.

Risks Factors

  • Age over 45 years
  • Increased pressure in the eye
  • Thinner corneas and chronic eye Inflammation.
  • High myopia (Nearsightedness)
  • Family History of Glucoma
  • Farsightedness (hyperopia)
  • Bleeding in your eye

Benefits

  • Iridotomy may increase angle width by 18 months.
  • The length of time the IOP remains lower depends on the type of laser surgery, the type of glaucoma, race age, and many other factors. 

Procedures Of Glaucoma Surgery

Surgery involves either laser treatment or making a incision in the eye to reduce the intraocular pressure. Your doctor  will recommended which type of surgery you will need, The surgery depending on the type and severity of your glaucoma and the general health of the your eye. Surgery can help lower pressure when medication is insufficient.

Laser surgeries: 

  • Trabeculopasty(Laser Trabeculoplasty):  Argon laser, Selective laser 
  • Iridectomy
  • Peripheral iridotomy-Nd:yag laser
  • Laser Cyclophotocoagulation
  • Laser Filtration Procedure.
  1. Trabeculopasty (Laser Trabeculoplasty) : A trabeculoplasty is a modification of the trabecular meshwork. Is uses a much focused beam of light to treat the drainage angle of the eye, located near the base of the iris, to increase fluid outflow. In the treatment of various open-angle glaucomas, LTP is used.                                  Types of laser trabeculoplasty: 
    1. Argon Laser Trabeculoplasty (ALT) : used an argon laser to create tiny burns on the trabecular meshwork.  It enhances the aqueous flow. It is Ineffective in pediatric glaucoma and most of glaucoma except pigmentary and pseudo exfoliatory types.This method prevents over correction and lowers the risk of increased pressure
    2. Selective Laser Trabeculoplasty (SLT) : newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork and create less thermal damage than ALTSLT is may be safely repeated.
  2. Iridectomy: It is also called as a corectomy or surgical iridectomy, it requires the removal of a portion of iris tissue.  These procedures are most often used in the treatment of closed-angle glaucoma and iris melanoma. Iridectomy is an intraocular surgical procedure where a small full thickness opening in the peripheral iris is making with the help of scissors.
  3. Peripheral iridotomy : Creating a full thickness hole in the pheripheral iris in order to alleviate the papillary block.  An iridotomy requires making puncture Performed either with standard surgical instruments or a laser, it is generally used to reduce the intraocular pressure in patients with angle closure glaucoma. This causes the iris to block fluid and increasing inner eye pressure. A Laser peripheral iridotomy (LPI) makes a small hole in the iris, allowing it to fall back from the fluid channel and helping the fluid drain. LPI the application of a laser beam to selectively burn a hole through the iris near it is base. LPI should be performed with either an argon laser or Nd:YAG laser.
  4. Laser Cyclophotocoagulation : An alternative to microsurgery that is typically used to treat glaucoma. This surgery is done for people who already have damage occur by glaucoma. Destroy ciliary body to reduce aqueous production.  Lasers type: diode and nd:yag.

  5. Laser Filtration Procedure : Filtering surgeries are the main stay of surgical treatment to control intraocular pressure. Filtering procedures are generally divided into two types: Penetrating and Non-penetrating. Both are depending upon whether an intraoperative entry into the anterior chamber occurs.

    Penetrating filtering surgeries are subdivided into guarded filtering procedures and full thickness procedures.

    Non-penetrating filtering surgeries do not penetrate or enter in to the eye's anterior chamber.  Types of non-penetrating surgeries: 1. Bleb-forming, 2. Viscocanalostomy.  

    Bleb forming:  Procedures invovles ab externo trabeculectomy and deep sclerectomy.   Viscocanalostomy: It is also an ab externo, major ocular procedure in which Schlemm's canal is surgically wide open by making a large and very deep scleral flap.

Post Procedures Of Glaucoma Surgery

Follow the instructions next 24 hours after surgery to minimize the risk of complications.

Eye care: Do not remove the Patch or eye shield for 24 hrs. Your eyes may feel sore and swollen after surgery which should go away in 1 to 2 weeks. Wear sunglasses for first 2 weeks after surgery.

  • Cover the operated eye while sleeping with the plastic shield for first 2 weeks after surgery.
  • Do not sleeping on the operated eye.
  • Remove the discharge from the eyelids after sleeping by gently wiping them with a clean and moist washcloth.
  • Used prescribed medications
  • Wash the hands before eye drops are placed in your eye.
  • Daily Activities: do not bend your head below your waist.
  • Do not lift heavy things.
  • Do not watch the telivision and don’t read.
  • Follow your normal diet of food and beverages.
  • Increase activities gradually between 2 to 4 weeks after surgery.

However, you should except to have some itching, irritation, foreign body sensation, and mild to moderate soreness. This is normal, but if you have any mild pain or discomfort, asked to your docto

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