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Glaucoma Surgery

A procedure performed to reduce the eye pressure to stabilize vision and prevent loss of vision in the future due to glaucoma is known as glaucoma surgery.

A group of eye conditions that lead to damage to the optic nerve where it leaves the eye is known as glaucoma. It can cause loss of vision.
The optic nerve is a nerve that carries images from the retina, which is a light-sensitive layer at the back of the eye, to the brain, allowing a person to see. 
In most cases of glaucoma, there is a fluid buildup in the front part of the eye. The extra fluid puts pressure on the eye and gradually damages the optic nerve. This pressure is known as eye pressure or intraocular pressure. However, some people having normal eye pressure can still get glaucoma.

Types:The different types of glaucoma include:
1. Open-angle glaucoma:

  • It is the most common type of glaucoma and accounts for approximately 90% of glaucoma cases.
  • It occurs due to the gradual buildup of fluid and pressure in the eye.
  • The canals that carry the fluid away from the eye fail to drain properly.
  • Deposits may form, which may further hinder drainage.

2. Normal-tension glaucoma:
This is a less common type of open-angle glaucoma. 
It is also known as normal-pressure and low-tension glaucoma.
The eye pressure may be considered to be normal for the general population, but it is considered to be too high for that particular eye and leads to optic nerve damage.

3. Closed-angle glaucoma:
This is a less common type of glaucoma.
It is also known as narrow-angle glaucoma, angle-closure glaucoma, and acute glaucoma.
It occurs due to the narrowing of the iris (the part of the eye that is responsible for a person’s eye color) or blocking of the drainage angle (the point where the iris and the white covering of the eye, known as the sclera, meet).
This causes an abrupt and rapid increase in eye pressure, leading to sudden symptoms.
This is a medical emergency and may lead to vision loss in a single day.

4. Congenital glaucoma:
It is a condition present at birth.
The condition occurs when the drainage system of the eye fails to develop properly during the development of the fetus.

Causes: Glaucoma occurs without any known cause but can be affected by several factors.
The most important factor that could lead to glaucoma is intraocular eye pressure.
The eyes produce a fluid known as aqueous humor, that helps in the nourishment of the eyes.
This fluid flows through the pupil (the dark-colored openings at the center of the eyes to let light in) to the front part of the eye.
In the case of a healthy eye, this fluid leaves through a drainage canal that is located between the iris and cornea (the outer clear layer at the front of the eye).
In the case of glaucoma, the drainage canals get clogged with microscopic deposits.
The fluid has no other place to go, so it builds up in the eye. 
This excess fluid starts to put pressure on the eye.
This elevated eye pressure eventually damages the optic nerve to cause glaucoma.

Risk factors: Certain factors increase the risk of developing glaucoma and may include:

  • High intraocular pressure
  • Age above 40 years
  • Asian, Hispanic, or black race
  • Family history of glaucoma
  • Having medical conditions like diabetes, high blood pressure, heart disease, or sickle cell anemia (a group of disorders leading to the breakdown or contortion of the red blood cells into a sickle shape)
  • Being farsighted or nearsighted
  • Having an eye injury
  • Having certain types of eye surgeries
  • Taking corticosteroid medicines or eye drops for a long time
Minimum Price : 40000 Maximum Price : 70000

Symptoms

Symptoms:
The symptoms of open-angle glaucoma usually arrive gradually and subtly. Many individuals having open-angle glaucoma have no noticeable symptoms early on. Closed-angle glaucoma may have more severe symptoms, that may arrive suddenly. 
The symptoms of glaucoma may include the following:

  • Headaches
  • Eye pressure or pain
  • Low vision
  • Blurred vision
  • Narrowed vision (tunnel vision)
  • Blind spots
  • Rainbow-colored halos around lights
  • Nausea
  • Vomiting
  • Red eyes

 

Diagnosis

The following regular eye exams are necessary to diagnose glaucoma or other eye-related problems:

  1. Dilated eye exam: This exam is done to widen the pupils and for the doctor to view the optic nerve at the back of the eyes.
  2. Gonioscopy: This is performed to examine the angle at which the iris and cornea meet.
  3. Ocular pressure test (tonometry): This test is performed to measure eye pressure.
  4. Optical coherence tomography (OCT): This test is performed to check for changes in the optic nerve that could indicate glaucoma.
  5. Pachymetry: This test is performed to measure corneal thickness.
  6. Slit-lamp exam: This test is performed to examine the inside of the eye using a special microscope known as a slit lamp.
  7. Visual acuity test (eye charts): This test is performed to check for loss of vision.
  8. Visual field test (perimetry): This test is performed to check for changes in peripheral vision (the ability of a person to view things off to the side).

 

Treatment

The treatment aims at improving the flow of fluid from the eye, reducing fluid production, or both. This can be done in the following ways:
1. Eye drops or medications:

  • Most people use eye drops as the initial means of treatment.
  • They help in either reducing the amount of fluid made by the eye or improving drainage.
  • The different types of eye drops that could be used for the treatment of glaucoma include prostaglandins, cholinergic agents, beta-blockers, carbonic anhydrase inhibitors, nitric oxide releasers, and rho kinase inhibitors.
  • The side effects of these eye drops could include redness, stinging sensation, headaches, dry mouth, change in the color of the eye or the skin around the eye, retinal detachments, or difficulty in breathing (rare).

2. Laser therapy:
Laser therapy is recommended when eye drops fail to improve glaucoma symptoms.
A high-energy beam of light is carefully aimed at a part of the eye to stop fluid buildup inside it.
The procedure is generally performed by putting local anesthesia drops in the eyes to numb them.
The different types of laser therapy are:

  1. Laser trabeculoplasty: A laser is used for opening up the drainage tubes within the eyes, allowing more fluid to drain out and reducing the eye pressure inside.
  2. Cyclodiode laser treatment: A laser is used for destroying some of the eye tissue that produces the liquid, which reduces the eye pressure.
  3. Laser iridotomy: A laser is used to create holes in the iris, allowing fluid to drain from the eye.

3. Surgery:
A glaucoma surgery is recommended in cases where eye drops or lasers have been ineffective.
Glaucoma surgery can be carried out under local anesthesia, which is used to numb the area of the surgery, or general anesthesia, in which the patient is put to sleep during the procedure.
The different types of glaucoma surgeries include:

  1. Trabeculectomy: This procedure involves the removal of a part of the drainage tubes to allow the fluid to drain more easily. Most patients do not need to take eye drops after this procedure.
  2. Trabeculotomy: This procedure vis similar to trabeculectomy, but it involves the use of an electric current to remove a small part of the drainage tubes from the eyes.
  3. Viscocanalostomy: This procedure involves the removal of a part of the sclera, to allow easy drainage of fluid from the eye.
  4. Deep sclerectomy: The drainage tubes in the eyes are widened in this procedure. This may be done by implanting a tiny device in the eyes sometimes.
  5. Trabecular stent bypass: A tiny tube is placed into the eye to increase the fluid drainage.

Risks

The following complications may be associated with a glaucoma surgery:

  • Pain
  • Bleeding
  • Infection
  • Allergic reaction to the medications, materials, or equipment used
  • Loss of vision
  • Reduced vision
  • Bleeding in the eye
  • Inflammation in the other eye
  • Excessive fluid drainage
  • Sharp increase in eye pressure
  • Hypotony (low eye pressure)
  • Scarring
  • Cataract formation (the clouding of the normally clear eye lens)
  • Failure of surgery

 

After Procedure

  • The patient usually goes home after a couple of hours following the surgery.
  • The surgeon needs to check the eye the day after the surgery.
  • Several follow-up appointments are scheduled in the weeks following glaucoma surgery. The surgeon will do minor adjustments, if required, during these appointments.
  • The patient may be given eye drops to relieve pain that may occur after surgery.
  • Most patients need to take about two weeks off from work after the surgery.
  • The patient may experience slightly blurred vision for up to six weeks after the procedure. The vision should return to normal after that.
  • Normal daily activities can be resumed within the first few days after the surgery.
  • Avoid swimming, bending the head below the waist, or lifting anything heavy for about four weeks after the surgery.

 

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