Surgery for Glaucoma

Trabeculoplasty

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“Conventional laser trabeculoplasty” is a para-surgical procedure used for the treatment of glaucoma open angle primary. In this case, the laser treatment is carried out on the corneo-scleral trabeculae, the ocular structure responsible for the drainage of the aqueous humor and whose obstruction causes an increase in intraocular pressure (IOP) responsible for glaucoma, increasing its porosity and draining capacity in percentage terms. As an alternative to conventional trabeculoplasty, a "selective laser trabeculoplasty" (SLT) can be used which by means of a "selective" irradiation of the pigmented cells of the trabeculae allows to increase the outflow of aqueous humor, without any collateral damage of a thermal type and with lower risk of inducing unwanted scar-like side effects. Both types of treatment are effective, last a few minutes, are painless and minimally invasive and usually do not involve risks or complications. The treatments can be repeated without any consequence, if over time they partially lose their effectiveness.

Trabeculectomy surgery aims to reduce intraocular pressure (IOP) in those patients with Glaucoma in whom drug therapy is no longer sufficient or in case the prescribed eye drops are not tolerated. The trabeculectomy surgery is classified as a filtering intervention and is suitable for all types of glaucoma, it takes place in the operating room, with a night of hospitalization for closer monitoring in the post-operative period. The operation lasts at least an hour, it can be performed both only under local anesthesia and under general anesthesia, a small fistula is practiced that connects the anterior chamber directly above (covered by the upper eyelid) with the sclera to allow the outflow of the excess aqueous humor in the subconjunctival spaces, and thus bring the IOP back to normal values for the patient.

Trabeculectomy

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YAG iridotomy

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The YAG laser iridotomy is a para-surgical intervention that is performed to prevent the onset of acute irido-lenticular block glaucoma in subjects at risk or to stop it in cases where it has already occurred. The high and sudden increase in intraocular pressure (IOP) - which in acute glaucoma can exceed 60-70 mmHg - represents one of the most serious ophthalmic emergencies that can lead to complete and irreversible blindness in a very short time.

The intervention consists in the creation of a small hole in the iris that allows to restore the outflow of aqueous humor prevented by the presence of a "block" created between the posterior surface of the iris and the anterior surface of the lens, with immediate lowering of the IOP . Preparing for the YAG treatment is very simple and consists in the instillation of a few drops of anesthetic eye drops on the surface of the cornea and in the painless application of a special contact lens that allows you to focus the laser beam on the iris and perform the treatment.

If the YAG laser is performed with preventive purposes, the patient can resume his normal activities having permanently averted the risk of an acute glaucoma attack. If, on the other hand, the treatment is carried out in the acute phase, it will be necessary to be sure that the ocular pressure has again and rapidly reached values such as to be compatible with the normal functionality of the optic nerve over time.

In most cases, pharmacological therapy (local or systemic) is prescribed at the same time, which helps to reduce the value of the IOP. Although not completely free from possible side effects related to the intervention (eg iris micro-hemorrhages, inflammation and transient ocular pressure rise) these are absolutely negligible compared to the irreversible damage to vision that would result from the absence of treatment.