The most common go-to surgical option for many doctors when it comes to glaucoma is laser surgery. Laser surgery is a treatment that you can choose to have at a clinic or your doctor's office.
Research shows that trabeculectomy can lower eye pressure in about 7 out of 10 people. It may work best in people who haven't had an eye injury or another eye surgery.
There are two common types of glaucoma surgery: laser and incisional.
Trabeculectomy is a very delicate operation that requires an operating room, local anesthesia of the eye, an anesthesiologist, and about an hour of operating time.
The most common treatment for glaucoma is prescription eye drops. They work by lowering the pressure in your eye and preventing damage to your optic nerve. These eye drops won't cure glaucoma or reverse vision loss, but they can keep glaucoma from getting worse.
Some of the newer medications on the market are eye drops called VYZULTA (latanoprostene bunod ophthalmic solution) and Rhopressa (netarsudil ophthalmic solution). VYZULTA is a modification of a current class of medications currently used to treat glaucoma – the prostaglandin analogs.
Selective laser trabeculoplasty (SLT) is increasingly being used as a first-line therapy to lower IOP by glaucoma specialists. SLT uses short pulses of low-energy light to target pigment in a glaucomatous eye. In response, the natural healing mechanisms of the body then rebuild these cells.
The drawbacks of trabeculectomy are that its efficacy is unpredictable, and there are too many complications. Patients' postoperative IOP can be too low or too high. Their wound-healing response can be modulated, but not always sufficiently.
Do not bend over or do any strenuous activities, such as biking, jogging, weight lifting, or aerobic exercise, for 2 weeks or until your doctor says it is okay. Avoid swimming, hot tubs, gardening, and dusting for 1 to 2 weeks. Wear sunglasses if your eyes feel sensitive to light.
Trabeculectomy, still considered the gold standard in glaucoma surgery (commonly performed today with an antimetabolite such as mitomycin-C), remains the most commonly performed glaucoma surgery, with a high success rate in most groups and glaucoma diagnoses, especially in the hands of an experienced surgeon.
MIGS is a state-of-the-art minimally invasive glaucoma surgery that uses microscopic instruments to facilitate small incision surgery. It provides a safer option to reduce eye pressure than conventional surgery, with the added benefits of a higher success rate and faster recovery time.
— Stand-alone microstent implantation and trabeculectomy are both effective at treating glaucoma, with the microstent possibly providing an alternative to trabeculectomy, according to a study presented here.
Most people who have glaucoma surgery do not experience significant pain. If you do feel pain in the eye, you should consult your eye doctor about the best options to relieve it.
According to our results, there was 5.3% chance that a patient with OAG would receive surgical treatment within five years of their first diagnosis. A retrospective study using the United States' claims database reported that 4.2% of patients with open-angle glaucoma received surgery within 48 months of diagnosis8.
The sutures do not dissolve and are usually removed in the clinic two to three weeks after surgery (this takes two to three minutes in clinic with the eye anaesthetised using eye drops). The eye usually starts to feel more comfortable after the sutures have been removed.
You may be awake during the surgery. You will receive a medicine to help you relax. You may also receive a shot (injection) or a topical numbing medicine (anesthetic) to numb the eye. This will keep you from feeling anything during the surgery.
How long a trabeculectomy remains viable varies widely; some trabeculectomies don't fail during the patient's lifetime. A few of my patients have had a working trabeculectomy for more than 20 years—although those patients are in the minority. The reality is that most patients who need a trabeculectomy are elderly.
The failure rates in the trabeculectomy group were 13.9% at 1 year,28.2% at 2 years, and 30.7% at 3 years. Failure was defined as persistent hypotony (IOP less than or equal to 5mmHg) or IOP > 21mmHg or IOP not reduced by 20% below baseline.
You may have some watering, sandy sensation or blurring of vision after trabeculectomy, but this should clear within a few days. Soreness and irritation may occur from the sutures or because of the surgery itself. These sensations generally reduce within a few days.
The average follow-up time was six years, with 73% of eyes displaying surgical success at the final follow-up. However, this percentage included those who needed additional medical therapy in come capacity. The percentage drops only slightly to 69% of eyes that needed no additional medical therapy.
Diets high in fruits such as have been shown to lower the risk of glaucoma development. The most discussed benefit is through antioxidants. As oxidative stress is associated with optic nerve injury, fruits high in antioxidants, such as pomegranate, acai berries, cranberries offer the most neuroprotection.
Glaucoma is one of the leading causes of blindness, and it has no cure.
But, glaucoma eye drops like Xalatan (prostaglandins) seem to be the best tolerated for most people. This, along with their once-daily dosing, make prostaglandin eye drops a go-to first choice.