In glaucoma, damage the optic nerve -- the nerve that carries visual stimuli to the brain -- results from an intolerance of the nerve to the pressure level within the eye. The eye's pressure -- and all eyes have pressure within them -- is created by fluid flow within the eye such that the eye makes and drains fluid constantly. The less easily the fluid drains out of the eye, the higher the pressure will be inside the eye. Every optic nerve has a pressure that it will not tolerate -- some very high, others quite low. But when the eye's pressure is too high for a particular optic nerve to tolerate, damage to the optic nerve can occur and lead to a loss of vision. When it is not possible to lower the eye pressure enough with the use of medication, procedures requiring either laser surgery or incisional surgery may be done to allow fluid to drain out of the eye more easily. The primary goal of glaucoma surgery is to reduce the amount of pressure in the eye and reduce or prevent loss of vision.There are different types of glaucoma procedures and different types of glaucoma. Glaucoma can affect people of all ages. The type of glaucoma surgery required will vary depending upon the type of glaucoma and also depending upon whether the patient is a child or an adult.
Generally there is no preparation for laser surgery. You should continue taking your regular glaucoma eye medication. Please have someone accompany you to drive you home. You will likely be scheduled to report to the clinic prior to the procedure for a pre-operative check. Click here for more general information on preparing for surgery
Both laser surgery and incisional surgery are done as outpatient procedures. This means that there is no overnight admission to the hospital. Our patients arrive in the morning and leave the same day.
Laser surgery, which is performed in an outpatient treatment room, takes from 10-15 minutes. For the most common type of glaucoma the laser procedure is called argon laser trabeculoplasty. In this procedure the laser spot is applied to the drainage mechanism of the eye to increase the outflow of fluid, thus lowering eye pressure. For a less common type of glaucoma -- called narrow angle glaucoma -- a different laser procedure, called peripheral iridectomy, is performed. Here the laser creates a tiny hole in the iris -- the colored part of the eye -- and allows the drainage area to widen. This prevents complete closure of the drain and subsequent extremely high eye pressure.
Incisional surgery is performed in the operating room. Although it usually takes about an hour, the patient is advised to plan to allow about four hours from the time of arrival until the time of discharge. The most common incisional operation for glaucoma is called a filtering procedure. There are different types of filtering procedures, but the one most commonly performed is called trabeculectomy. In this operation a small incision is made in the eye and a flap of tissue covers the incision allowing a slow release of fluid from the inside of the eye to the outer layers. In more complicated cases -- perhaps after one or two trabeculectomies have not been adequate to reduce the eye pressure -- a seton (or tube) may be placed inside the eye. This small device drains fluid to the outer layers of the eye.
Following laser surgery, you will be reminded not to rub your operated eye for about 20 minutes, until the effects of the numbing eye drop has worn off. You will sometimes be instructed to return to the clinic so your eye pressure can be checked one to two hours following the laser surgery. You may resume all normal activities, including your regimen of glaucoma medication immediately.
Following incisional surgery after a short stay in the recovery area you may go home or to a hotel. You should plan to have someone else drive you and stay with you that night. You will be advised to refrain from strenuous activity.
Follow-up visits to the clinic following both laser surgery and incisional surgery will be scheduled to closely monitor the progress of your eye.
As with any surgical procedure, eye surgery always carries with it potential risks. In the case of laser surgery, these risks are minimal, but patients need to understand that there could possibly be loss of vision, eye discomfort or pain, elevation of eye pressure, or the need for further medication or surgery.
With incisional surgery, the risks while generally still small are, nevertheless, greater than with laser surgery. Any incision on the body carries with it the risks of bleeding or, later, infection. Loss of vision can follow incisional eye surgery. The eye may be inflamed (red), uncomfortableóeven painful. The eyeís pressure may not reduce as was intended with the surgery. In fact, occasionally the pressure could be too high or too low and require additional medication or further surgery. Loss of vision following eye surgery is always a potential occurrence and, on the rarest of occasions, an eye can be lost following surgery. As with any surgery, your surgeon will explain the surgery and discuss the potential benefits and risks. These need to be weighed and balanced as you and your surgeon together decide what is best to treat your glaucoma.
For more information: Contact the
Glaucoma and Cataract Clinic, or
Comprehensive Ophthalmology Clinic at the U-M Kellogg Eye Center (734) 763-1415.
Click here for a complete list of surgical procedures at the Kellogg Eye Center.
