Glaucoma Care – Glaucoma Surgery FAQs.

Glaucoma is the name given to a range of conditions in which people experience nerve damage, usually with increased pressure within the eyeball, leading to permanent and irreversible damage to the optic nerve, with eventual blindness if left untreated.

It is an operation performed to treat glaucoma. The operation entails forming a small channel through the white part of the eye. This channel will allow fluid – made naturally in the eye – to drain away. Some patients will require a special medication (Mitomycin C) to be placed around the incision site to try to ensure that the hole does not scar over. The drainage site is under the upper eyelid and will not be seen, and once settled should not cause you discomfort. The fluid will drain from the channel and be absorbed by conjunctival vessels in the skin of the eye. In an eye not suffering from glaucoma, the fluid normally drains away through a sieve-like structure found around the iris. This structure is called the trabecular meshwork. If this meshwork becomes clogged up for any reason, pressure will build up inside the eye, pressing on the blood vessels which supply the optic nerve. Without an adequate blood supply, the optic nerve is starved and begins to die. As a result of this, portions of sight in the eye can be permanently lost.

Glaucoma can be treated with eye drops, which have to be instilled every day throughout the patient’s life time. If treatment with eye drops fails to control the pressure in the eye, an operation may be necessary. In other cases an operation may not be essential, but may be offered as an alternative to instilling eye drops constantly. Laser treatments are suitable for some patients but are not always permanently effective in lowering pressure.

The majority of patients having this surgery have it under local anaesthetic (the eye is numbed with special fluid drops and the patient is awake). For some patients this is not appropriate and they will have a general anaesthetic or some sedation.

Most local anaesthetic patients can go home the same day of surgery assuming they have good vision in the other eye or have someone with them that evening. Many patients choose to stay overnight if this is difficult. Patients having a general anaesthetic may have to stay overnight.

Unfortunately, the operation cannot bring back any sight that has been lost. After the operation, your sight may be blurred and seem worse. This is only a temporary situation, and is to be expected after an operation. Your eye will need time to heal and settle down following surgery. This generally takes about 6-8 weeks in total.

Evidence shows that surgery is most effective at lowering eye pressure and the lower the eye pressure the lower the risk of blindness from glaucoma!

It is a very successful operation, which will in most cases, save the remaining sight of the eye. Following surgery, in 80% of cases no further treatment is necessary. In 10-15% of cases, drops to reduce pressure will still be needed. In 5-10% of cases, a further operation or treatment is necessary.

Any additional treatment is chargeable and not included in the original quote for the first surgery. However, our surgeons do not charge a fee for treating any complications.

There is a small risk of bleeding in the eye at the time of surgery. This usually clears gradually. There is also a small risk of over drainage so the pressure is too low. This usually settles but may need extra treatment. There is also a very rare risk of late infection. The rate of development of a Cataract may become accelerated after glaucoma surgery, and this may require lens surgery to improve your vision.

Read
Watch TV
Go for walks
Cook
Wear glasses/sun glasses in the day
Wear an eye shield for 2 weeks at night
Rest and take things easy

Rub your eye
Undertake strenuous exercise
Do heavy gardening or housework

Mitomycin C and 5-FU decrease the amount of scar tissue formed around the new drainage site, thereby increasing the flow of fluid in this new channel, and helping to keep the pressure low. They can be used during and/or after surgery. They do carry a small increased risk of infection, and corneal complications, but can dramatically increase your chances of success.

Non penetrating surgery is an option but can be less effective than a trabeculectomy. A minimally invasive trabeculectomy with a Express micro-shunt implant gives the benefit of both as it lower pressure effectively and reduces complications, and surgery time, but can significantly increase the costs of the procedure. If you have any further questions please do not hesitate to contact your surgeon or email us at reception@londonoc.co.uk