What is Involved in Glaucoma Surgery?

Glaucoma surgery is a procedure in which a surgeon creates drainage ducts in the eye in order to reduce interocular pressure and/or prevent a future rise in interocular pressure. Developments in ocular surgery have created a variety of techniques that surgeons regularly use. Laser trabeculoplasty, trabeculectomy and the implantation of valves are the most common surgical methods of treating glaucoma. Examination before surgery will help a surgeon decide which route is best.

No matter the type of glaucoma surgery, most patients can expect to be awake during the procedure. Only in the cases of children and the elderly do surgeons administer general anesthesia. Instead, the patient will receive both numbing eye drops and oral medication to reduce stress during the operation. Surgery begins after a brief wait period to allow sedation to set in.

Laser trabeculoplasty is a newer technique in glaucoma surgery. Pulses of laser light create tiny holes where the cornea and iris meet. These holes will become pores, allowing interocular fluid to drain. Surgery is quick and causes very little tissue damage. If interocular pressure raises at a future date, a patient can safely undergo the procedure a second time.

Though the use of laser trabeculoplasty has risen, trabeculectomy has been the most recommended form of glaucoma surgery. In this procedure, a surgeon uses a scalpel to remove a small part of the eye's drainage system. First, the surgeon creates a flap at the border between the cornea and sclera, the white part of the eye. The flap is pulled back, and the surgeon creates a small hole that allows the release of interocular fluid. The flap is put back into place, and the interocular fluid has more room to circulate.

In cases where trabeculectomy fails, valves give patients another chance at improved sight. In this form of glaucoma surgery, a surgeon implants a small plastic valve into the eye, bypassing the natural drainage system. The valve is held in place by stitches and a small piece of donor sclera. If the surgery is a success, the implanted valve will be able to self-regulate the release of interocular fluid.

Post-operative care is an essential part of any glaucoma surgery. Though the surgeon most likely will administer anti-inflammatory, steroidal and anti-bacterial eye drops immediately after surgery, the patient will be responsible for self-administering these drugs for a period of days or weeks. Also, patients will have to wear eye protection during sleep and while showering for a period of time as determined by the surgeon. Not following post-operative care instructions can greatly increase the chances of complications such as infection, vision loss or blindness.