Traditional glaucoma surgeries are both a safe and effective way to treat glaucoma by decreasing intraocular pressure, preventing further vision loss, and stopping the progression of the disease. It is sometimes the preferred method of treatment depending on the patient’s condition. It is typically performed as a trabeculectomy, or involves the insertion of a drainage device. Following surgery, patients may experience discomfort in the eye that may last for a few days, and should avoid bending or lifting heavy objects for at least a week. It is also advised that patients avoid wearing eye makeup, getting water in they eye, or swimming for at least 4 weeks to avoid infection.
A trabeculectomy is a procedure in which the surgeon creates a small scleral flap along with a fluid reservoir over a surgically created hole. This is know as a filtration bleb. The aqueous fluid will be able to drain out the flap and into the bleb where the fluid is abosrbed by the surrounding tissue, lowering intraocular pressure.
The Ahmed Glaucoma Valve is a silicone device with a drainage tube inserted in glaucoma patients, particularly those with Neovascular, congenital, and uveitic glaucoma. During the procedure, an incision is made in the conjuctiva and tenon's capsule. A pocket is formed between the rectus muscles, and the valve in inserted and sutured in. The drainage tube is then inserted in the anterior chamber, and covered with donor sclera, cornea, or the like and sutured in. The procedure will typically take 45 minutes to an hour, and both local anesthesia and IV sedation are required.
A “bleb” is a fluid resvior that is formed over a surgically created hole. Sometimes, scar tissue will start to cover the drainage hole. Bleb needling is an effective way to reopen a failed or closing filtration bleb. With a slit lamp, the surgeon uses a 25 to 30 gauge needle to puncture the wall of the bleb multiple times to disrupt the scar tissue and revive the bleb. This procedure is typically outpatient and requires local anesthesia.
An Ex-PRESS Shunt is a stainless steel shunt that is placed under the scleral flap creating a filtration bleb. It is typically inserted after other surgical treatments have failed. A conjuctival incision is made along with a 4mm by 4mm scleral flap, and the very small shunt is inserted under the scleral flap. Self-dissolving sutures are used to close the conjuctiva and scleral flap. The procedure typically takes 20-45 minutes, and requires local anesthesia.
Kahook Dual Blade Goniotomy
Kahook Dual Blade Goniotomy (KDB) is a procedure used on patients undergoing cataract surgery with mild to moderate glaucoma. A stainless steel, single-use blade makes parallel incisions in the trabecular meshwork and the inner wall of the Canal of Schlemm. The blade stretches the TM in order for the surgeon to remove the diseased portion of the TM to increase aqueous flow.