Glaucoma

Selected ophtalmology treatments and their medical experts, specialists and clinics in Switzerland - Ticino

Glaucoma is the name given to a group of ocular disorders of varying origin which can lead to a loss of neurofibres and, in extreme cases, to blindness of the affected eye. The treatment options are drugs, surgery and laser operations.

Advantages

Without treatment, glaucoma can cause within months, rarely even within days, a decrease of vision.

Indications

Your ophthalmologic examination revealed a glaucoma, eye disease due to an increase in intraocular pressure and/or inadequate perfusion of the optic nerve with typical disease of the optic nerve. 
The regulation of the intraocular pressure is achieved by the aqueous humor. It is produced in the anterior segment of the eye, flows into the anterior chamber and finally is reabsorbed through the iridocorneal angle in the canal of Schlemm.

In the case of disturbance of the flow, the aqueous humor builds up inside the eye and increased intraocular pressure. At first, the visual acuity does not change, the patient does not feel nor the change in the level of the optic nerve or visual field change. Without treatment, glaucoma can cause within months, rarely even within days, a decrease of vision.

In the case,  the intraocular pressure can not lower in a sufficient manner with medication (drops, tablets, a surgery will be necessary. The goal is to improve the flow of aqueous humor or decrease the production of aqueous humor.

Procedure

What to expect

The surgery is made in most cases under local anesthesia retrobulbar (anesthetic injection behind the eyeball). It is rarely necessary to perform a general anesthetic.

70% of patients with elevated intraocular pressure can be adjusted sufficiently with the intervention. It may be necessary to continue with the medications (drops) used before surgery may, eventually may be necessary to resume after years of surgery. In some cases it may be impossible through the intervention decrease the intraocular pressure, which increases progressively with very high values ​​(malignant glaucoma). In this case, further treatments, for example a touch-up with the treatment iris, cataract operation, cryo coagulation or vitrectomy (removal of the vitreous body) may become necessary.

Preparation

Before surgery, please advise our specialist if you are taking anticoagulant medicines (Marcumar, Sintrom) or antiplatelet drugs (Aspirin, Tiatral) to be able to suspend two weeks prior to surgery.

Treatment plan

There are different types of interventions. Run under the operating microscope, some with the help of laser. List of possible interventions used nowadays:

Iridectomy
Is in the periphery of the iris, through surgery or a laser form a small opening to improve the flow of aqueous humor through the iridocorneal angle. The main indication for this intervention is an acute increase in intraocular pressure (acute glaucoma).

Filtering operation
Through a small opening in the sclera is created a new way out for the aqueous humor up under the conjunctiva, then is created a small iridectomy (hole in the periphery of the iris). The iridectomy can also be created before the surgery with a laser. The surgery improves the flow of aqueous humor from the anterior segment of the eye.

Engraving iridocorneal angle (goniotomy, trabeculotomy, goniocuretage)
in the case of congenital glaucoma is realized a separation of small membranes in front of the peculo, which occlude the way out through a small knife or with other instruments. In this way is increase the flow of aqueous humor in the anterior segment.

Viscocanolostomia
Is made an incision in the iridocorneal angle and inject a gelatinous product in the canal of Schlemm to improve the flow.

Sclerectomy
The surgery is performed with the incision of the iridocorneal angle and then with the excision of a small piece of the sclera over the canal of Schlemm. The ciliary body, responsible for the production of aqueous humor, is cryo coagulated or scarred by laser light. Later the production of aqueous humor decreases. This method is often used in the case of secondary glaucoma, for example after a venous thrombosis in the eye or in response to a disease advanced diabetic.

Laser treatment in the iridocorneal
With a local anesthesia of the cornea is applied to a contact lens on the eyeball and the iridocorneal angle is treated in seven positions with laser light of low intensity. This treatment is used for reducing an increase of intraocular pressure  not too high.

Combination of filtering operation with cataract surgery (cataract surgery and glaucoma)
The modern surgical techniques allow to operate cataract and glaucoma in two times or one. Before is made a cataract surgery with phacoemulsification and implantation of the lens and implantation of an artificial lens, the is realized a filtering operation.

Deep iridectomy
It is a new method with the creation of a subconjunctival bleb without entry into the anterior chamber. During surgery, a small piece of sclera is removed above the canal of Schlemm.

Recovery

After surgery it is necessary to suture the small opening in the eye with very fine points. The suture material can be reabsorbed by itself after a few days or weeks, or it can be left in place or removed in one of the post-operative.

To ensure good healing is applied an antibiotic ointment regularly and, after the intervention, is applied a bandage eye. In the case of congenital glaucoma or secondary glaucoma, for example after an inflammation of the eye, a thrombosis of the eye or in diabetes mellitus, is often necessary to use medicaments which prevent the scarring of the conjunctiva (anti-metabolites, for example mitomycin C, fluorouracil). These medicines can be applied only once during the intervention (mitomycin C) or several times after surgery (fluorouracil) locally.

Recommended behavior after treatment or therapy

After surgery:

  • please avoid physical exercise after surgery
  • please apply the drops regularly and take the tablets prescribed
  • it is absolutely necessary to regularly check the pressure in the eye in the controls in the study
  • please notify your specialist immediately in the case of strong reddening of the operated eye, sharp pains or headaches or visual decline
  • after surgery you can not drive the car

Risks & complications

The intervention of glaucoma and the laser treatment are part of the basic surgery in ophthalmology. However, there is no surgery without complications.

With an operation of filtration may be necessary to touch the output channel for a revision in the event of Atalamia (flat anterior chamber). A persistent cataract may worsen more quickly after this  intervention. Other possible complications are bleeding in the eye, wounds, infections and side effects to medicines, occlusion of the central vessels of the eye or of the central vessels of the optic nerve caused by periocular injections. These can cause a decrease in visual acuity or visual acuity loss. Allergic reactions (heart, breathing, circulation) are extremely rare, abundant nerve and eyelid anesthesia may cause a passenger disturbance of mastication.

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