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Glaucoma Topics

 

Incisional Glaucoma Surgery

Incisional surgery is generally reserved for cases where medication and laser have failed to adequately control glaucoma. (See target pressure)

Surgery Experience

Your eye is prepared for surgery by surgical nurses. This takes 30-45 minutes.Our anesthesiologist will give you relaxing medicine, and your surgeon will anesthetize the eye.After the eye is anesthetized, it is cleansed with antiseptic and draped for surgery using sterile technique.This is microscopic surgery. It takes 30-60 minutes, depending on the complexity of the situation.After surgery, you will rest in the recovery area for approximately 30 minutes.Plan on spending a total of about 2 hours at the surgery center.After surgery, a friend or relative must drive and escort you to your home where you should relax quietly for the rest of the day.

Most patients feel well but tired. You'll probably sleep very well that night.

Trabeculectomy: the most common incisional surgery

trabeculectomy flaptrabeculectomy blebThe "standard" glaucoma surgery involves fashioning a new drainage path from the inside of the eye, through a "flap" (like a trap door) into the space under the conjunctiva (the clear tissue layer that can be considered to be the "skin " over the white of the eye). Typically an "antimetabolite" medication is applied to the area at the time of surgery, and possibly at postoperative visits, to keep scar tissue from "clogging" the new drainage path. This surgery works well most of the time, but sometimes fails. There are treatments for "failing bleb," and sometimes the surgery may need to be repeated or a different procedure performed.

Valve, Canalostomy, Seton surgeries

These procedures are most often done when trabeculectomy has failed or my be inadvisable. They are intricate, and generally don't lower the eye pressure as much as a successful trabeculectomy. It is hoped that one of these therapies will some day emerge as both safer and more effective than trabeculecomy.

All glaucoma surgery is considered "temporary," but the hope is that they will last a number of years. The success rate for glaucoma surgery varies with the nature and stage of your glaucoma. In best cases, the success rate for intraocular pressure control approaches 75%, but many cases eye drops will still be needed.

Alternatives to Incisional Surgery

Untreated, glaucoma is one of the leading causes of world wide blindness. Medication is effective for most patients. Some need or prefer to have glaucoma laser treatment. Incisional surgery is generally done after medication and laser have been deemed insufficient in reaching a target pressure. In some European countries, surgery is done at an earlier stage than in the US.

Potential Complications

As with all types of surgery, complications are possible. Every effort is made to minimize risk, but serious or long-term complications including failure to achieve results, inflammation, discomfort, continued need for medication, permanent loss of vision and need for further surgery can occur. Discuss this with your surgeon before consenting to surgery. Remember that uncontrolled glaucoma is a potentially blinding condition and even though the treatments are imperfect, your doctor is recommending a plan that he believes offers you the best chance to keep your vision over the long haul.