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Glaucoma Surgery

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Glaucoma surgery is surgery to lower pressure inside the eye.

Glaucoma

Reasons for Procedure

It is done to treat glaucoma . The inside of the eye is normally bathed by a clear fluid. The fluid flows in and out of the front chamber of the eye. In most cases of glaucoma, this fluid flows too slowly out of the eye. The fluid builds up and increases the pressure inside the eye. If this pressure is not controlled, it can cause damage to the eye and loss of vision. This surgery is done to lower the amount of pressure in the eye. Decreasing the pressure may be needed to prevent further loss of vision.

It is important to note that while glaucoma surgery may save your remaining vision, it does not improve or restore sight.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have glaucoma surgery, your doctor will review a list of possible complications, which may include:

Sensitivity to light
Infection
Long-term irritation and inflammation of the eye
Bleeding
Loss of vision
Need for more surgery

Risk factors for complications include, but are not limited to:

Obesity
Smoking
Diabetes
High blood pressure
Heart and lung disease
Bleeding disorders
Infection

What to Expect

Prior to Procedure

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

Aspirin or other anti-inflammatory drugs
Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)

Continue to use your eye drops, unless directed otherwise by your doctor.
Arrange for a ride to and from the procedure.

Anesthesia

Drops are used to numb the eye for the procedure.

Local anesthesia and sedation may be used for incisional surgery.

General anesthesia is used under some circumstances.

Description of the Procedure

There are two common types of glaucoma surgery: laser and incisional.

Laser Surgery

The main types of laser surgery include:

Argon Laser Trabeculoplasty (ALT)

Argon laser trabeculoplasty (ALT) is the most common type of laser surgery. It is usually used to treat open angle glaucoma. During this procedure, you will sit facing the laser machine. The laser "spot" will be applied to a special contact lens held on the front of the eye. You may see flashes of red or green light as the laser is applied. This procedure will allow more fluid to be released and relieve some of the pressure.

Selective Laser Trabeculoplasty (SLT)

The procedure is similar to ALT. SLT has the benefit of being repeatable. ALT cannot be done more than twice.

Laser Peripheral Iridotomy (LPI)

Laser peripheral iridotomy (LPI) is frequently used to treat narrow-angle glaucoma or to prevent glaucoma attacks in patients with anatomically narrow angles. Narrow-angle glaucoma occurs when the angle between the cornea (the clear structure on the front of the eye) and the iris (the colored part of the eye) is too small. This can cause the iris to plug up so that fluid cannot flow freely. This can cause the pressure to rise to dangerously high levels very quickly. In LPI, the laser will be used to make a small hole in the iris. The hole will allow fluid to flow more freely within the eye.

Cyclophotocoagulation

Cyclophotocoagulation is used to freeze the parts of the eye that make the eye fluid. This procedure is usually done only in people who have severe damage from glaucoma and for whom other surgeries were not successful. Instead of freezing, this procedure can also be done with a laser.

Incisional Surgery (also known as Filtering Surgery)

This surgery uses tiny instruments to remove a piece from the wall of the eye. This creates a small hole, which is covered by conjunctiva (layer around the eye). The fluid can now drain out through the hole. It will then be reabsorbed into the bloodstream. This reduces the pressure in the eye. In some cases, the doctor may place a valve in the eye through a tiny incision.

Glaucoma Implants

If the above methods fail, another option is the use of implants. With implant surgery, most of the device is positioned on the outside of the eye. A small tube or filament is carefully inserted into the front chamber of the eye. The fluid drains through the tube, or along the filament, into the area around the back end of the implant. The fluid collects here and is reabsorbed. This procedure is slightly more risky than standard trabeculoplasty and should only be performed by doctors well-versed in the technique.

How Long Will It Take?

The procedure usually takes less than one hour. People having the incisional procedure may need about 4-8 hours from the time of arrival until discharge.

Will It Hurt?

For most people, the local anesthesia will block pain during surgery. There may be some burning or stinging with ALT and LPI. Some people report mild discomfort during the procedures. Incisional glaucoma surgeries tend to have more discomfort after the procedure than laser procedures.

Post-procedure Care

At the Care Center

After the procedure, you may be given:

An eye exam
Eye drops
An eye patch

At Home

Be sure to follow your doctor's instructions .

If given an eye patch or bandage, wear it as directed.
Use eye drops as prescribed. These drops will often help prevent infection and inflammation.
Avoid activities that expose your eye to water, like swimming.
Ask the doctor about how to wash your face and when it is safe to shower or bathe.
Refrain from heavy lifting, straining, or driving until allowed by your doctor.
Follow your doctor's advice regarding resuming exercise and other activities.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Sudden and/or severe eye pain
Loss of vision or other eyesight changes
Signs of infection, including fever and chills
Nausea or vomiting
Redness, swelling, increasing pain, excessive bleeding, or any discharge from the eye
Pain that you cannot control with the medicines you have been given
Cough, shortness of breath, or chest pain

In case of an emergency, call for medical help right away.

RESOURCES:

Glaucoma Research Foundation http://www.glaucoma.org/
Prevent Blindness America http://www.preventblindness.org/
National Eye Institute http://www.nei.nih.gov/

CANADIAN RESOURCES

Canadian Ophthalmological Society http://www.eyesite.ca/
University of Ottawa Eye Institute http://www.eyeinstitute.net/main.html

References:

American Academy of Ophthalmology website. Available at: http://www.aao.org/ .
National Eye Institute website. Available at: http://www.nei.nih.gov .
Ophthalmology Clinics of North America. 2005;18:409-419.

Last reviewed [Under Medical Review] by Christopher Cheyer, MD

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