Glaucoma Surgery

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).

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.

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

• 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.