Glaucoma surgery: procedure, goals, risks

Definition

What is glaucoma surgery?

Glaucoma surgery, as the name implies, is a surgical procedure performed to treat glaucoma. Glaucoma itself is damage to the optic nerve caused by high pressure on the eyeball.

Glaucoma surgery is an important part of glaucoma treatment. The risk of more severe damage to the eye can be reduced by undergoing this surgery. If not treated properly, glaucoma can be fatal and lead to permanent blindness.

The goal of this operation itself is to reduce pressure on the eyeball, as well as reduce pain in the eye that is compressed by excess fluid.

What types of glaucoma surgery are there?

Basically, there are 2 types of surgery that are defined as the standard for treating glaucoma, namely laser and trabeculectomy. Laser is usually the first action a doctor takes. If you don't succeed in lowering the pressure of your eyeball, you may need to have a trabeculectomy.

For laser surgery, there are 4 types of procedures that are generally performed. The type of laser you will get depends on the severity and type of glaucoma you have.

Here are some types of laser surgery used in the treatment of glaucoma:

1. Argon laser trabeculoplasty (ALT)

ALT is a laser surgery intended for primary open angle glaucoma patients. This type of laser will open blockages in the eye fluid ducts, so that the drainage system (drainage) in the eye works better.

The doctor will likely work on half of the blockage, see how your eye is doing, then work on the next part at a later time.

According to an article from Indian Journal of Ophthalmology , approximately 75% of glaucoma patients show improvement after undergoing ALT procedure.

2. Selective laser trabeculoplasty (SLT)

SLT is a method that uses a low-power laser. The SLT laser will only target certain cells in the eye that have high pressure.

Similar to the ALT laser method, this SLT laser method is equally aimed at cases of open angle glaucoma. In addition, if the ALT laser is not working effectively on the patient, the doctor will recommend the SLT method.

3. Laser peripheral iridotomy (LPI)

The LPI method is generally used in patients with angle closure glaucoma, which is a condition when the angle of drainage between the iris and the cornea is completely closed. With LPI, the doctor will make a small hole in the iris with a laser, so that the eye fluid can flow out into the drainage channel smoothly.

4. Laser cyclophotocoagulation

Laser action type cyclophotocoagulation performed if the patient's eye condition has not shown progress after undergoing the types of lasers above. The laser will be aimed directly inside the eye to reduce pressure.

If the four types of lasers above do not have a significant effect, your doctor will advise you to choose a procedure trabeculectomy, or an eye incision.

Trabeculectomy is performed by making a small incision in the sclera ((white part of the eyeball). This incision will act as a drainage for fluid from the eyeball. The success rate of trabeculectomy is about 70-90%.

When do I need to have this surgery?

It is important for you to know that surgery is generally not the first choice of glaucoma treatment. Doctors only recommend surgery if treatment with eye drops has not succeeded in reducing the pressure on the patient's eyeball.

Patients who also experience side effects of glaucoma eye drops, such as hypertension or irregular heartbeat, are also advised to undergo this procedure.

In addition, in some cases, surgery may need to be performed as soon as possible if the high pressure in the patient's eye is out of control even with medication, and the patient's vision is threatened.

Glaucoma Operation Process

What should I do before having surgery?

Before undergoing surgery, first discuss with your doctor the risks and benefits of the surgery that you will undergo. In addition, the doctor will also ask about what drugs are being consumed, allergies you have, or other health conditions before the operation begins.

It is also important for you to follow your doctor's instructions regarding drugs, foods, or drinks that are not consumed before surgery.

How is the glaucoma surgery process?

Following are the steps you will undergo during the glaucoma surgery process:

1. The doctor will give an anesthetic or local anesthetic to the eyeball and surrounding area. This is so that you don't feel pain during the operation.
2. The doctor will use a microscope equipped with a slit lamp to see the eyeball structure more clearly during the surgery.
3. The operation usually lasts 45-75 minutes, depending on the type of surgery being performed. Sometimes, you may still feel your eyeballs being touched even though there is no pain at all. If you feel uncomfortable, tell your doctor.

What should I do after surgery?

Usually, you are allowed to go home a few hours after surgery. You may need to visit your surgeon for several weeks afterward to control the results of the surgery, follow-up examinations, and make various adjustments.

Postoperative recovery time will usually vary, depending on age, medical condition, type of glaucoma, and the patient's activities. For the laser method, you can return to normal activities the next day. Meanwhile, you will need 1-2 weeks of rest after undergoing trabeculectomy surgery.

Some other things you also need to pay attention to after having glaucoma surgery, include:

• Avoid driving, reading, bending over, or lifting heavy weights for the next 4 weeks.
• Don't get your eyes wet for a while.
• Your eyes may feel watery, a little painful, blurry, and red after surgery. Consult a doctor if this effect is quite disturbing.

Side Effects and Complications

What are the side effects and complications of glaucoma surgery that can occur?

Side effects and complications that are quite common after undergoing glaucoma surgery are the appearance of cataracts. In addition, there is a possibility that the incision or hole from the operation will cause a small lump called a bleb.

Other complications that can occur after surgery are as follows:

• blurred vision
• bleeding into the eye
• sudden and permanent loss of vision
• eye infection
• pressure in the eye that is still high, or too low

Long-term complications after trabeculectomy include:

• cataracts that are more severe than before surgery
• changes in the nerves behind the eye associated with glaucoma
• drooping eyes (slight drooping of the eyelids)

Consult your doctor if you experience certain complaints or concerns, either before or after surgery.