Depending on the type of glaucoma you have, different treatment options may be considered. Treatment options include topical (prescription eye drops), laser therapy, and conventional glaucoma surgery. Many cases of glaucoma can be controlled with one or more drops, but some people may require surgery to reduce their IOP further to a safe level by improving the outflow or drainage of fluids. Occasionally, surgery can eliminate the need for glaucoma eye drops.
Laser Procedures and Surgery
An in-office laser treatment may be used to treat glaucoma. An iridotomy is a laser procedure used to treat narrow/closed angle glaucoma. Another type of laser treatment, trabeculoplasty, is used to treat open angle glaucoma, especially when drops are unsuccessful. Types of laser trabeculoplasty include Argon Laser Trabeculoplasty (ALT) and Selective Laser Trabeculoplasty (SLT). During a trabeculoplasty, a laser is directed into the trabecular meshwork, the drain of your eye. The effect of this laser treatment develops over several weeks, and can last up to several years. When its effectiveness lessens, it can often be repeated.
Micro Invasive Glaucoma Surgeries (MIGS)
ABiC: Ab Interno Canaloplasty (ABiC), a minimally invasive glaucoma surgery that can effectively reduce the elevated eye pressure associated with glaucoma. ABiC is based on the same principles as angioplasty, a procedure that opens blocked arteries and restores normal blood flow to your heart muscle. It uses breakthrough micro catheter technology to enlarge your eye’s natural drainage system, improving outflow and lowering eye pressure. With this single-handed instrument, your surgeon is able to lower the intraocular pressure of the eye by surgically opening the eye’s natural drainage system without permanently implanting a device within the conjunctiva or sclera. The surgery begins by accessing the area using a single self-sealing, clear corneal incision, an ab-interno approach. A cannula is inserted through the incision that contains a microcatheter which can be advanced 360 degrees around the eye. Your surgeon is able to deliver controlled amounts of viscoelastic fluid directly into Schlemm’s canal, where the drainage takes place, as the microcatheter is retracted. This jelly-like fluid will stretch and widen the canal which is designed to increase the outflow of fluid from the eye, thereby lowering the pressure of the eye. This can be done as a stand-alone procedure or combined with cataract surgery.
Trabeculectomy 360: With this single-handed instrument, your surgeon is able to lower the intraocular pressure of the eye by surgically opening the eye’s natural drainage system without permanently implanting a device within the conjunctiva or sclera. The surgery begins by accessing the area using a single self-sealing, clear corneal incision. A cannula is inserted through the incision that contains a microcatheter which can be advanced 360 degrees around the eye. The drain of the eye is manually opened while retracting the microcatheter. By doing so, the surgeon removes any blockage which allows a smooth output of the fluid directly through the canal. This lowers the buildup of fluid causing excessive pressure within the eye. This can be done as a stand-alone procedure or combined with cataract surgery.
iStent Trabecular Micro-Bypass: A newer surgical therapy for glaucoma that is designed to improve aqueous outflow to safely lower IOP may reduce the need for glaucoma eye drops – this is at the discretion of the doctor. iStent is the smallest medical device ever approved by the FDA. It is placed in the eye during cataract surgery. iStent is so small that a patient isn’t able to see it or feel it after surgery, but it will work continuously to help reduce eye pressure.
XEN®45 Gel Stent: Dr. Nairn was one of the first surgeons in Pennsylvania to perform this innovative glaucoma implant. The XEN® Glaucoma Treatment System is designed to reduce intraocular pressure in eyes suffering from refractory glaucoma, including cases where previous surgical treatment has failed, cases of primary open-angle glaucoma, and pseudoexfoliative or pigmentary glaucoma with open angles that are unresponsive to maximum tolerated medical therapy. The device creates a permanent channel through the sclera allowing flow of aqueous humor from the anterior chamber (AC) into the subconjunctival space. Clinical trials support the efficiency of the Xen® Gel Stent in those patients who have failed prior in multiple surgical procedures.
Kahook Dual Blade: This device allows the surgeon to reduce intraocular pressure (IOP) by removing a section of trabecular meshwork and the inner wall of Schlemm’s canal. The Kahook Dual Blade procedure is quick and painless, requiring no sutures and providing rapid postoperative visual recovery. The Kahook Dual Blade procedure can be performed as a standalone procedure, or in combination with cataract surgery. Topical medications are normally used to manage postoperative recovery.
Endoscopic Cyclophotocoagulation (ECP)
A laser procedure that is often performed at the same time as cataract surgery for patients who suffer from both cataracts and glaucoma. Recent studies show that patients who undergo the combined ECP/cataract surgery need fewer glaucoma medications over the long term.
Trabeculectomy (filtration surgery)
Performed to reduce eye pressure in patients with open-angle glaucoma, trabeculectomy is usually done when other treatments for glaucoma have failed to adequately lower eye pressure. The goal of this surgery is to lower eye pressure to prevent further loss of vision from glaucoma. During trabeculectomy surgery, a new drainage passage is created to filter fluid from the eye. This new opening allows the fluid inside the eye to drain out of the eye, bypassing the trabecular meshwork, the clogged drainage passages present in people with glaucoma.
Ex-PRESS® Mini Shunt
A type of trabeculectomy in which the fluid in your eye is diverted through an extremely small tube to the outside of the eye. Although the device is as small as a grain of rice, it acts just like a heart stent keeping a pathway open so blood (or fluid) can successfully go around the blockage. The Ex-PRESS provides precise control of the amount of fluid that is allowed to flow out helping the eye maintain a healthy level of internal pressure.
Seton Tubes or Glaucoma Tube Shunts
These devices that are implanted in the eye to provide an artificial alternative drainage site for fluid to exit the eye. These devices lower eye pressure. A tiny tube extends from the body of the device into the anterior chamber, which is the front part of the eye that usually drains fluid from the eye. The device allows excess fluid to drain out through the tube and be absorbed in surrounding tissues. These implants fall into two categories: non-valved (free flow implants; i.e. Baerveldt) and valved (resisted-flow implants; i.e. Ahmed)