Surgical Glaucoma Treatment Options
If medications alone do not achieve the desired results or have intolerable side effects, our doctors may suggest surgery for glaucoma management.
Trabecular Bypass Stent Surgery
To implant a trabecular bypass stent, your ophthalmologist will create a small incision in your cornea. Then he or she will place a stent, which looks like a tiny tube, into part of the eye’s drainage system. The stent allows fluid to bypass an area that is not draining efficiently. This reduces eye pressure.
With laser trabeculoplasty, your surgeon will put a special contact lens on your eye. This helps focus and deliver the light from the laser to the precise location. The surgeon applies the low energy laser to the area called the trabecular meshwork; this is where fluid naturally drains from the eye. The laser causes microscopic changes in the eye’s tissue allowing fluid to drain better, reducing eye pressure.
In glaucoma implant surgery, the drainage implant is usually placed in the area under either the upper or lower eyelid. Your ophthalmologist will stitch the implant to the sclera, the white part of your eye. Your ophthalmologist may cover the tube of the implant with a patch. Fluid will drain out to the area around the implant. A tiny tube is attached to the drainage implant and inserted into the front chamber of the eye, usually just in front of the iris. The tube sends fluid from the inside of the eye to the implant where it is absorbed into the body.
With laser iridotomy, the ophthalmologist uses a focused beam of light to create a tiny opening about the size of a pinhead in the iris; this opening allows trapped fluid behind the iris to flow into the front of the eye, usually reducing pressure. A laser iridotomy is an important way to treat or prevent a sudden rise in eye pressure that can seriously affect your eyesight.
Mini Filtration Implants
In mini filtration implant surgery, your ophthalmologist will create a small flap underneath the upper eyelid in the sclera, the white part of your eye. Then he or she will implant a tiny drainage device under the flap. This device is called a mini shunt, which opens a pathway for fluid to drain from inside the eye. The fluid collects in an area around the implant caused a filtering bleb, where it is gradually absorbed into the body.
During trabeculectomy surgery, your ophthalmologist makes a tiny incision in the conjunctiva, the clear lining over the sclera (or the white part of the eye); this is done under your upper eyelid and near the edge of the iris. Next, he or she will create a small flap in the sclera underneath the incision. Then, a tiny piece of tissue is removed under the flap to make an opening into the eye. A small piece of the iris may also be removed to keep it from blocking the opening. This opening serves as a new channel for fluid to drain gradually from the eye, reducing pressure. The flap is sewn back into place with tiny stitches, which help guard against too much fluid draining out at once. The area where the fluid drains from the trabeculectomy is called a filtering bleb. As fluid filters out of the eye and into the bleb, it looks like a bubble. Because the bleb is under the eyelid, it is not usually visible.