What are the reasons for chronical glaucoma?
In a healthy eye, the surface of the ring muscle continuously produces aqueous fluid – the aqueous humour - inside the eye. This muscle is located at the front of the eye directly behind the iris. From there the aqueous fluid circulates round the lens and the inner cornea supplying both with nutrients. In a small ring canal in front of the iris at the margin of the sclera, the aqueous fluid flows back into the draining blood vessels.
An obstruction of the draining is the most frequent cause of an increase of intraocular pressure. This increased intraocular pressure as well as low blood pressure causes a poor circulation in the eye. Often this is the cause for the dying of the visual nerve´s nerve cells. Once this damage has occurred it is called glaucoma.
Beginning changes of the visual nerve often do not show symptoms. The most frequent risk factor is an increased intraocular pressure. Blind spots in the visual field indicate an advanced state of the disease.
Only an ophthalmologist can make an early diagnosis of glaucoma: intraocular pressure as most important risk factor is measured and the visual nerve examined. With specific ophthalmologic analysis undetected glaucoma can be spotted.
If there is a suspected case of glaucoma computer-based systems can supply important information. The changes in the visual field are analysed, the visual nerve thoroughly examined with modern scan systems and even the smallest changes are documented for the course of the disease.
Glaucoma: the therapy.
The intraocular pressure and the preservation of the visual nerve of glaucoma patients can be regulated in the long-term with regular medication with special eye drops.
If despite treatment a further deterioration of the disease should occur, a laser or surgical treatment should be taken into consideration. Contrary to popular opinion it is possible to operate glaucoma; the surgeon has to be highly experienced. Your ophthalmologist will advise you.
If the cause for the disease is low blood pressure it is important that ophthalmologist and general practitioner collaborate in order to stabilise the blood circulation. In the long run major fluctuations or a nightly drop of blood pressure can lead to the so-called normal-tension glaucoma. There are glaucoma patients whose eyesight can be saved by a cardiac pacemaker or by stopping the antihypertensive medication at night.
Glaucoma: the surgery.
In Germany up to 20.000 glaucoma surgeries are carried out annually. There are various methods; the most frequent are trabeculotomy, fistula surgery (trabeculectomy) or laser surgery.
Laser trabeculoplasty (often called ALT or SLT) is a treatment near the drainage system of the aqueous humour (in the drainage angle). The treatment is similar to a routine examination - while the patient is sitting the eye is sedated with eye drops. The treatment takes only a few minutes. In most cases the intraocular pressure can be lowered; if necessary SLT can be repeated several times.
Trabeculoplasty (drainage of internal pressure)
With trabeculotomy the microscopic ring canal that drains the aqueous fluid into the blood system is sought out and probed. Then the ring canal is opened carefully so that the aqueous fluid can regain its natural drainage and freely flow out of the front part of the eye. The wound is sutured with microscopic absorbable surgical threads. Finally cortisone is injected next to the eye to avoid excess scarring.
Like cataract surgery glaucoma surgery is carried out under local anaesthesia. The stay in the surgery area is less than one hour; mere surgery takes about 25 minutes.
Fistula surgery/Trabeculectomy (drainage of external pressure)
Fistula surgery procedure is similar to trabeculotomy; the sclera is sutured loosely back in place and the conjunctiva closed in a tight fashion thus creating a so-called filter cushion - a bleb which drains the aqueous humour underneath the conjunctiva. An extensive follow-up treatment is essential for the bleb.
There are a variety of special implants that have been developed for the draining of aqueous humour. One of the most recent is the XEN implant. It is introduced through a small incision in the eye via the iridocorneal angle into the space under the conjunctiva thus creating a similar drainage canal as in trabeculectomy. An excess scarring of the conjunctiva in the area of the filter cushion is avoided by this minor trauma surgery.
Laser surgeries that reduce the production of aqueous humour
There are many possibilities to apply laser with glaucoma. The most successful is the laser cyclo destruction: the ciliar epithelium of the ciliar body is cauterized with approximately 20 laser impulses of an infra-red laser. This reduces the regeneration of aqueous humour. For surgery the laser probe is placed on the numbed conjunctiva.
(see image) Every laser irradiation lasts about 2 seconds. This can lead to a dull pressure pain. There is no need for cutting or suturing the eye.
To avoid an excessive reaction laser radiation is used in low doses; this can lead to the necessity of a follow-up laser treatment after several months.
What happens after glaucoma surgery?
The day after surgery the first check takes place either at Smile Eyes or at your ophthalmologist. Should the intraocular pressure temporarily still be too high, it can be lowered with pills or eye drops.
It is not unusual that after trabeculotomy you can only distinguish dark and light. For one-eyed persons this means an intensive care by family, nursing services or an inpatient admission that should be planned before surgery. Sometimes a complete recovery takes up to two months and there is the possibility that you cannot drive a car in this period. Since the wound is slightly bigger than with cataract surgery during these two months you will feel a minor foreign body sensation. In a few cases you will also feel the microscopic threads. In this case they can be removed already in the 2nd week after surgery. Otherwise they are absorbed within 8 weeks.
After a laser cyclo destruction the eye recovers much faster than with trabeculotomy. Even with a successful glaucoma surgery there is the possibility that through scarring the pressure will increase anew. In about 60% of the cases a single surgery is sufficient for long-term pressure regulation – therefore your ophthalmologist should check your intraocular pressure lifelong several times a year and if necessary your visual nerve or your visual field. If after surgery pressure cannot be regulated properly with eye drops a laser cyclo destruction is recommended as 2nd surgery.
In a very advanced state of glaucoma even after successful surgery a further deterioration of the visual nerve is possible so that surgery not always prevents a threatening blinding.
What is a Glaucoma attack?
Glaucoma attack is a rare, acute painful disease with very high intraocular pressure. In combination with severe head-ache and nausea one eye reddens rapidly, loses vision and threatens to go blind. An immediate ophthalmological treatment with infusions and an emergency treatment are vital. Cause is a shortened eyeball with a block of the iridocorneal angle by the iris or a loosened or thickened lens which has shifted forward in the eye and blocks the drainage of aqueous humour.
Ophthalmologists in most cases can estimate the probability of an acute attack, they suggest a preventive laser treatment (iridotomy) or surgery where a drainage is placed in the outer region of the iris or the thickened lens is exchanged in the course of a cataract surgery.
Is there a possibility that the visual nerve regenerates and the vision meliorates once the glaucoma surgery has been carried out?
No, the damage of the visual nerve is irreparable. That´s why early diagnosis is so important. In any case after glaucoma surgery you should have your intraocular pressure regularly checked by your ophthalmologist. Unfortunately after successful surgery glaucoma can return any time.
The Smile Eyes plus in safety
- Extensive preliminary examination and consultation exclusively by experiences ophthalmologists
- Modern surgery units with up-to-date certified hygienic standards
- State of the art laser technology
- Highly qualified surgeons with year-long experience
- Regular aftercare
- Fair price management
- Quality management according to ISO 9001