Over the recent years there have been a number of developments in the surgical management of glaucoma using minimally invasive techniques that are performed in combination with cataract surgery or as standalone procedures. These devices, such as the iStent and the Hydrus stent, are performed in the operating room under local anesthesia. These implanted devices have a very high safety profile and improve the outflow of aqueous. After implantation they are effective, in most instances, of reducing intraocular pressure and are often useful in reducing the number of eye drops needed to treat mild to moderate glaucoma.
The XEN gel stent is a small microstent that is inserted into the eye to allow for an alternative route of fluid to drain from the eye underneath the conjunctiva, which is the skin covering the eye. The XEN stent may be performed as a standalone procedure, or in combination with cataract surgery.
The procedure normally takes 10-20 minutes to perform. After the procedure patients are prescribed a topical antibiotic to be taken for 1 week and a topical steroid to be taken for 4 weeks.
The Kahook Dual Blade and the OMNI System are both devices that perform what is called a trabeculotomy. A trabeculotomy is an opening into the trabecular meshwork, which is the natural internal drainage system for aqueous fluid. This procedure increases the outflow of fluid from the eye and thereby reduces the intraocular pressure. The procedure with either device normally takes about 5-10 minutes to perform and is often performed in combination with cataract surgery. Both can, however, also be performed as a standalone procedure in patients who have not had prior cataract surgery. The OMNI procedure additionally dilates the trabecular meshwork to increase aqueous outflow.
After the Trabectome procedure, patients are prescribed a topical antibiotic for 1 week and a topical steroid for 4 weeks. Patients are also prescribed a medication called pilocarpine, which constricts the pupil, for 4 weeks.
In the most severe cases of glaucoma, where laser, medical and often other surgical procedures have failed to control intraocular pressure or in severe cases where very low intraocular pressures are needed to preserve vision, additional procedure are available and are highly successful.
Trabeculectomy is a type of glaucoma surgery performed on the eye that creates a new pathway for fluid inside the eye to be drained to a fistula created on the surface of the eye. This is an outpatient procedure performed in the operating room. It is used to prevent worsening of vision loss due to glaucoma by lowering eye pressure.
After trabeculectomy, patients prescribed a topical antibiotic for 1-2 weeks and a topic steroid for 4 weeks.
Glaucoma shunt insertion is a surgical procedure that creates an alternative route for fluid to get out of the eye. Glaucoma shunt insertion is often performed after medical and laser treatments are unsuccessful at controlling the glaucoma. Compared to a trabeculectomy, glaucoma shunt insertion inserts a shunt into the eye to drain fluid to an extraocular reservoir that is covered by the conjunctiva, which is the skin covering the eye.
After glaucoma shunt surgery, patients prescribed a topical antibiotic for 1-2 weeks and a topic steroid for 4 weeks.
Cyclophotocoagulation (CPC) is a procedure normally performed in the operating room under local anesthesia. It uses laser energy to target the ciliary body epithelial cells, which are the cells within the eye responsible for the production of aqueous fluid. By treating these cells the production of fluid can be reduced and the intraocular pressure is decreased.
A newer version of CPC is called micropulse-CPC (mCPC). Similar to transscleral CPC, mCPC is normally performed in the operating room under local anesthesia. With mCPC, the laser energy is spread out in a more diffuse manner when compared to transscleral CPC. mCPC is effective at lowering the eye pressure and has a lower risk of complications when compared to transscleral CPC. It is often used in advanced disease where the risk of incisional surgery carries a greater risk of permanent vision loss, and for patients that may not be able to tolerate incisional surgery.
After mCPC, patients are prescribed a topical steroid medication for 1-4 weeks.
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