Glaucoma Surgery



Although vision that has been lost by glaucoma cannot be recovered, there are treatments available that can stop vision loss from getting worse. Laser and surgical procedures are designed to lower the pressure inside of the eye and to prevent further damage to the optic nerve.

Argon Laser Trabesculoplasty (ALT)

The most common type of laser surgery performed for open-angle glaucoma is called Argon Laser Trabeculoplasty (ALT). The objective of the surgery is to help fluids drain out of the eye, reducing intra-ocular pressure that can cause damage to the optic nerve and loss of vision.

Although your eye care professional may suggest ALT surgery at any time, it is often performed after trying to control intra-ocular pressure with medicines. In many cases, you will need to keep taking glaucoma medications even after ALT surgery.

ALT is for Those:

  • who have been diagnosed with glaucoma
  • whose doctor has determined that ALT is appropriate for controlling their intra-ocular pressure

What to Expect on Procedure Day:

Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.

Your doctor will hold up a special lens to your eye as a high-energy beam of light is aimed at the lens and reflected onto the trabecular meshwork inside your eye. You may see flashes of bright green or red light. Your doctor will make 50-100 evenly-paced laser applications in 10-15 minutes. This will be done in one or two treatment sessions. The laser beam will cause some areas of your eye's drain to shrink, resulting in adjacent areas stretching open to permit the fluid to drain faster. You will not feel any pain during the procedure.

Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside your eye. You should relax for the rest of the day. Follow-up visits are necessary to monitor your eye pressure. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medication, many patients are eventually able to discontinue some of their medications. Most patients resume normal activities within a few days.

What to Expect After Surgery:

The effect of the surgery may wear off over time. Two years after ALT surgery, the pressure from glaucoma increases again in more than half of all patients. Serious complications with ALT are extremely rare, but like any surgical procedure, it does have some risks. You will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is a relatively new laser treatment for open angle glaucoma.  SLT uses short pulses of low energy laser light to target melanin-containing cells in a network of tiny channels, called the trabecular meshwork. The objective of the surgery is to help fluids drain out of the eye, reducing intra-ocular pressure that can cause damage to the optic nerve and loss of vision.

The selective technique is much less traumatic to the eye than ALT, which has been the standard laser procedure. ALT can cause tissue destruction and scarring of healthy cells in the trabecular meshwork structure. SLT reduces intra-ocular pressure without this risk. SLT can be used to effectively treat some patients who could not benefit from ALT. This includes patients who have already been treated with ALT.

Although your doctor may suggest laser surgery at any time, it is often performed after trying to control intra-ocular pressure with medicines. In many cases, you will need to keep taking glaucoma drugs even after laser surgery.

SLT is for those:

  • who have been diagnosed with glaucoma
  • whose doctor has determined that SLT is appropriate for controlling their intra-ocular pressure

What to Expect on Procedure Day:

Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking.

Your doctor will hold up a special lens to your eye as a high-peak power beam of green light is aimed at the lens and reflected onto the meshwork inside your eye. You may see flashes of bright green or red light. The laser will selectively target melanin-containing cells, resulting in increased fluid outflow. You will not feel any pain during the procedure. It takes 10-20 minutes.

Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside the eye. You should relax for the rest of the day. Follow-up visits are necessary to monitor your eye pressure. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medication, many patients are eventually able to discontinue some of their medications. Most patients resume activities within a few days.

What to Expect after Surgery:

The effect of the surgery may wear off over time. Serious complications with SLT are extremely rare, but like any surgical procedure, it does have some risks. Going to a specialist experienced in SLT can minimize the risks.

If you and your doctor decide that SLT is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction. If you would like more information about this procedure you can make an appointment or contact the office for additional information.

Filtration Surgery (Trabeculectomy)

Filtration surgery, also called trabeculectomy, is a treatment for several types of glaucoma including open-angle and narrow-angle glaucoma. It is often performed on patients who have not responded well to medication or laser treatment such as ALT or SLT. Filtration surgery usually provides a dramatic reduction in pressure within the eye.

Filtration Surgery is for Those:

  • who have been diagnosed with glaucoma
  • whose doctor has determined that filtration surgery is an appropriate treatment for their condition

What to Expect on Surgery Day:

The area around your eyes will be cleaned and a sterile drape will be applied. You may be given a sedative to help you relax. Your eye will be numbed with topical or a local anesthesia. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking.

Your doctor will create a tiny new channel between the inside of your eye and the outside of your eye. A small section of tissue will be removed, creating a channel, to allow fluid to pass through the blocked drainage network onto the white (sclera) of the eye. The incision will be closed with small stitches and covered with the thin outer tissue of the eye, called the conjunctiva. Blood vessels in the conjunctiva will carry the draining fluid away.

To keep the drainage channel open, your doctor may apply an extremely small dose of a chemotherapeutic agent to the new filter. Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside the eye. You should go home and relax for the rest of the day. Most patients resume normal activities within a few days.

Follow-up visits are necessary to monitor your eye pressure. It may take a few weeks to see the full pressure-lowering effect of this procedure, and adjustments may need to be made to the filter during this period. These adjustments may include:

  • injection of small amounts of chemotherapeutic agents
  • loosening or removal of one or more stitches
  • finger pressure to the eye to force fluid through the filter
  • numbing the eye and opening the channel slightly with a fine instrument
  • placing a contact lens over the eye

What to Expect After Surgery:

The success rate for this type of surgery is approximately 80 percent in cases where no surgery has been done on the eye before. However, everyone's eyes are unique and many people do require further treatments. In more difficult cases where even filtration surgery doesn't prevent damage to the ocular nerve, it may be necessary to perform other types of procedures.

Serious complications with filtration surgery are extremely rare, but like any surgical procedure, it does have some risks. Going to a specialist experienced in filtration surgery can significantly minimize the risks.

Minimally Invasive Glaucoma Surgery: MIGS

iStent by Glaukos

iStent is the first MIGS device that improves your eye’s natural fluid outflow to safely lower eye pressure by creating a permanent opening in the trabecular meshwork. Proven safe and effective, the iStent Trabecular Micro-Bypass:

  • Is safely implanted during cataract surgery
  • Spares important eye tissue that is often damaged by traditional surgeries
  • Does not limit treatment options that could help maintain your vision in the future

iStent is the smallest medical device ever approved by the FDA. It is placed in your eye during cataract surgery and is so small that you won’t be able to see or feel it after the procedure is over. iStent is designed to create a permanent opening in your trabecular meshwork, and works continuously to improve the outflow of fluid from your eyes to help control eye pressure.

For patients with combined cataract and open-angle glaucoma, iStent reduces introcular pressure (IOP) by improving aqueous humor outflow. Inserted through a 1.5-mm corneal incision, iStent is the only FDA-approved device for the treatment of mild to moderate open-angle glaucoma.

Gyclo G6 Glaucoma Laser System
Cyclophotocoagulation with Micropulse Technology

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