Glaucoma surgery is a radical treatment. As a rule, it is used as a last resort or for health reasons. But even this method does not give 100% of the result, but only delays the symptoms, slows down the progression of the disease. It will not be possible to restore or improve eyesight, it is only possible to maintain the level that exists before surgery.
Is it worth it to make an operation with such a poorly optimistic prognosis only for you, but only until the disease is in its early stages. Unfortunately, even the very advanced course of glaucoma, complicated by complete blindness, also has to be operated on. The unresolved problem of high intraocular pressure (IOP) causes severe pain, which is accompanied by inflammation, up to the amputation of the eye.
Indications for surgical intervention are determined by an ophthalmologist. It depends on the stage, course of the disease, type, compliance with its medical treatment, patient age, the presence of concomitant diseases, tolerability of certain drugs, and so on.
Is glaucoma treated without surgery
Identified in the early stages and correctly corrected open-angle form of the disease does not require surgical intervention. The constant use of drugs, regular examinations by an ophthalmologist, and observing the visual regimen will allow you to successfully deal with pathology without a scalpel or laser.
But in the case of, for example, an acute attack of a closed-angle form of the disease, surgery is urgently needed, since if you do not lower the critical IOP values within a couple of hours, your vision will be lost forever.
Preparation for surgery
Private clinics suggest faster preparation for anti-glaucoma surgery without prior hospitalization. The patient comes to the doctor in the morning, on the same day he undergoes all the necessary examinations and is operated on. By evening, they can let him go home, leaving him in a day hospital.
State-style hospitals operate according to the regulations, the patient is hospitalized in a hospital on the eve of surgery. For this day, he is fully examined, an anamnesis is collected, consultations of the main specialists, the type of anesthesia with an anesthesiologist is selected. At night, the patient is prescribed a sedative sedative, and in the morning they are operated on. After the operation with the patient, a relative or nurse should be in the ward, as vision will be limited.
Key recommendations for preparing for surgery:
- It is forbidden to drink, eat at least six hours.
- It is necessary to pass a general analysis of blood, urine, blood for sugar, take an ECG, undergo fluorography.
- Undergo a series of specific ophthalmological examinations to measure eye pressure, study the condition of the fundus, retina, determine the shape and type of glaucoma.
- Elderly patients over 75 years of age require accompanying relatives to monitor the process of proper preparation for surgery.
- For a week, taking a number of drugs that affect blood coagulation, blood pressure and antibiotics are limited.
- If the attack is acute, then operational resolution occurs with a minimum set of examinations.
Surgical treatment of glaucoma is divided into microsurgical methods and laser surgery. The difference between these two types of operations lies in the method and nature of the intervention. The laser in this regard is a more gentle, non-penetrating method of operation, which does not require prolonged anesthesia. The operation is performed under local anesthesia. This method for treatment has established itself as the most safe, inexpensive, but also temporary and with its type of complications.
The operation is quick, painless. Contraindication may be intolerance to drugs for anesthesia or an allergic reaction.
Laser treatment of glaucoma is used in the early stages of the disease, it is aimed at eliminating the causes of disturbances in the outflow of moisture from the chambers of the eyeball. With the help of a laser, the drainage system of the eye is restored, and excess intraocular fluid is discharged. A plus is the lower cost of this procedure compared to surgery.
During the operation, a special gonioli lens is put on the eye, due to which the laser beam is focused in the right place.
The main disadvantage of all laser interventions is the short duration of the effective treatment period, on average 1-4 years, then scarring of the artificially created outflow occurs.
- Laser iridotomy. One of the treatments for angle-closure glaucoma. The possibility of this operation does not depend on the stage or degree of the disease. Using a laser, several holes are burned in the iris between the posterior and anterior chamber of the eye, thereby forming a new mode of communication for intraocular fluid.
- Laser gonioplasty. It is indicated for use in angle-closure glaucoma and iridotomy inefficiency. In this case, tissue is evaporated by the laser, covering the outflow angle between the iris and the cornea, thus restoring the natural drainage system.
- Laser trabeculoplasty. Used for open angle glaucoma. Plastic drainage outflow of aqueous humor is performed. The channel expands, is cleared of clogging sites, restores its patency.
In this type of treatment for glaucoma, exposure to cold (liquid nitrogen) occurs on the sclera, in the projection of ciliary cells that produce aqueous humor. This method involves the destruction of part of these cells and thereby reducing the production of IOP. Also, due to the effect on the sclera, the application points become thinner and have a pronounced exudative effect, thereby dropping excess fluid through the refined walls.
The advantage of this type of intervention is instant analgesia due to exposure to cold, vasoconstriction, lack of bleeding.
Surgical treatment of glaucoma is indicated in the absence of the effect of laser treatment, with repeated or unsuccessful interventions, with advanced stages and complications. For example, when the eye is affected by glaucoma and cataract at the same time.
Glaucoma surgery is extensive and characterized by various types of intervention, including amputation of the eyeball. We will consider only the main ones.
You can find out the exact cost only in that medical institution where you are going to do the operation itself. The presence of the policy will make it possible to carry out an operation to remove any form of glaucoma free of charge in state medical institutions. As a rule, laser methods are less expensive, they cost 8-10 thousand rubles.
Surgical iridectomy is performed to treat the angle-closure form of glaucoma, an acute attack, or elective open-angle treatment. Due to the closure of the outflow angle between the iris and the cornea, intraocular pressure rises sharply, which leads to a violation of the trophism of the optic nerve, and the death of visual cells.
In this case, the edge of the iris is removed to create conditions for communication between the two chambers for intraocular fluid. The excised part of the iris has a larger diameter, scarring longer, has a relatively longer therapeutic effect relative to the laser method.
Trabeculectomy for glaucoma is one of the types of fistulating operations, which consists in removing the clogged part of the trabecular (drainage) network of the eye.
This allows you to improve, enhance the outflow of aqueous humor, thereby reducing and returning to normal intraocular pressure.
This is a surgical procedure, based on which the muscles that hold the lens are cut off and the connecting sutures are superimposed, which gives additional space for the free circulation of intraocular fluid.
This is a method in which the risk of fibrosis and postoperative scarring is reduced, one of the types of repeated surgical interventions. Drainage implants and valves are installed to discharge excess fluid. One of these valves is the Ahmed valve, which is actively used in glaucoma. Allows you to control the level of intraocular pressure, quickly respond to its changes.
More information about Ahmed’s valve, treatment with this and other methods in the video:
Unfortunately, complete recovery of vision after surgery for glaucoma will not occur. If the eye no longer sees before surgery, then after the miracle will not happen. Vision can only be maintained at the original, initial level. The operation does not restore visual function, it reduces IOP, thereby preventing its further loss. Glaucoma after surgery may return. How soon – it depends on your observance of the visual regimen, medical support.
What can not be done after surgery:
- Touch, remove the bandage, check the level of vision.
- To arbitrarily experiment using drops not prescribed by the doctor for the eyes.
- Supercool, skip scheduled examinations.
- Too much coffee or tea.
You can learn more about the postoperative period from the following video:
Complications after surgery:
- hemorrhage, redness of the sclera;
- excessive decrease in intraocular pressure;
- inflammatory diseases of the eyeball;
- scarring causing a second attack of the disease.
The most basic drawback of all surgical treatment methods is their short duration. Unfortunately, mankind has not yet fully learned to heal glaucoma, but it is possible to fight and stop it.
Surgical intervention is possible only with the written consent of the patient and close relative. This consent confirms your awareness of all risks and consequences, so do not hesitate to ask your doctor any questions you may have.