Glaucoma surgery: When should it be performed and what techniques are available?

In most cases glaucoma can be controlled with drugs or laser procedures. However, sometimes this is not enough and glaucoma surgery is necessary, which will be even more effective and will help to control the pressure and eventually eliminate the use of eye drops.

How is glaucoma defined?

Glaucoma is defined as a chronic and progressive deterioration of the optic nerve, a process normally caused because the patient has high intraocular pressure, but this is not always the case, as there are also glaucomas with normal intraocular pressure.

In order to treat it, it is necessary to reduce the intraocular pressure in order to slow down or reduce the damage to the optic nerve. Treatment usually begins with topical drugs or laser. If the patient does not tolerate it or does not improve, surgery will be used.

What types of glaucoma surgery are there?

The main types of glaucoma surgery are:

  • Deep non-perforating sclerectomy. This is the surgery of choice, normally, if major glaucoma surgery is required. It consists of making a small communication window in the upper sclera (white area of the eye), between the inside of the eye and the conjunctiva. In this way, the aqueous humor is evacuated and the excessive pressure in the eye is reduced. In order to avoid any possible early failures of the surgery or erroneous scarring, anti-scarring drugs and implants, such as intrascleral implants, Ologen or Mitomycin, will be used. This is the safest technique in terms of postoperative complications. In addition, recovery is faster and postoperative comfort is also greater.
  • Trabeculectomy. This is the classic filtering glaucoma surgery. As with the previous technique, it is based on opening an aqueous humor outflow pathway from the anterior chamber of the eye to the subconjunctival space with the aim of reducing intraocular pressure. It is indicated in cases where non-perforating deep sclerectomy cannot be performed. The postoperative period, unlike the previous case, is less predictable and has slightly more complications, although they can be solved in consultation.
  • Valves or drainage devices. Some cases of patients who have already undergone glaucoma surgery require reintervention. Sometimes in these patients, specialists propose the implantation of a valve device, which is an implant that is placed under the conjunctiva and, by means of a very thin tube, communicates the inner space of the eye, draining the aqueous humor towards the implant, favoring the lowering of intraocular pressure.
  • New techniques: MIGS or minimally invasive surgery. These glaucoma surgeries are easier to perform, more effective and with few postoperative complications. In addition, these techniques are more comfortable for the patient, since stitches are not usually used, as in the previous techniques. This technique also consists of establishing a communication or outflow pathway for the aqueous humor from the inside of the eye to the outside in order to reduce pressure. Xen devices may be a solution for certain types of glaucoma.
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In any case, it will be the Ophthalmology specialist who will determine the type of glaucoma the patient suffers from and which technique will be most indicated, in case surgery is necessary.