Our Summary

Glaucoma surgery has come a long way since its early, invasive methods. While once the “gold standard” was a technique called trabeculectomy, this method had some serious side effects. As a result, the medical community moved towards non-penetrating surgeries, like deep sclerectomy and viscocanalostomy, which were safer but did not have long-lasting effects.

This led to the development of minimally invasive glaucoma surgery (MIGS), which is a gentler procedure performed through a small incision in the cornea. As surgical tools and techniques continue to improve, the options for treating glaucoma are expanding. This review examines the current state of MIGS, analyzing its effectiveness and discussing the latest techniques in use or under investigation. The goal is to continue to elevate the standard of glaucoma treatment worldwide.

FAQs

  1. What was the “gold standard” technique for glaucoma surgery and why did it change?
  2. What is minimally invasive glaucoma surgery (MIGS) and how is it performed?
  3. What are some of the latest techniques in glaucoma surgery currently in use or under investigation?

Doctor’s Tip

One helpful tip a doctor might tell a patient about glaucoma surgery is to follow the post-operative care instructions carefully. This may include using prescribed eye drops, attending follow-up appointments, and avoiding activities that could put strain on the eyes. By following these instructions, patients can help ensure the success of the surgery and maintain their eye health in the long term.

Suitable For

Patients who are typically recommended for glaucoma surgery are those who have been diagnosed with glaucoma and have not been able to adequately control their intraocular pressure (IOP) with medication or other non-surgical treatments. Additionally, patients who are experiencing progression of their glaucoma despite treatment may also be recommended for surgery.

Specifically, patients who may benefit from glaucoma surgery include those with:

  • Primary open-angle glaucoma
  • Angle-closure glaucoma
  • Normal-tension glaucoma
  • Secondary glaucoma (e.g. from trauma or uveitis)
  • Patients who are unable to tolerate or adhere to their glaucoma medications

It is important for patients to discuss their individual case with their ophthalmologist to determine if glaucoma surgery is the right option for them. The decision to undergo surgery should be based on a thorough assessment of the risks and benefits, as well as the patient’s overall health and lifestyle.

Timeline

Before glaucoma surgery, a patient typically undergoes a comprehensive eye exam to determine the severity of their condition and assess their overall eye health. The doctor may also perform various tests, such as visual field tests and imaging scans, to gather more information about the patient’s specific case of glaucoma.

After the decision to proceed with surgery is made, the patient will receive instructions on how to prepare for the procedure, which may include avoiding certain medications or fasting before surgery. On the day of the surgery, the patient will be given anesthesia to ensure they are comfortable during the procedure.

During the surgery, the surgeon will make a small incision in the eye to access the drainage system and improve the flow of fluid, which helps to lower the intraocular pressure that causes damage to the optic nerve in glaucoma patients.

After the surgery, the patient will be monitored closely for any complications or side effects. They may experience some discomfort or blurry vision initially, but this should improve as the eye heals. The doctor will likely prescribe eye drops or other medications to help with healing and prevent infection.

In the weeks and months following surgery, the patient will have follow-up appointments with their doctor to assess the success of the procedure and make any necessary adjustments to their treatment plan. It is important for patients to continue to monitor their eye health and follow their doctor’s recommendations for managing their glaucoma to prevent further vision loss.

What to Ask Your Doctor

  1. What type of glaucoma surgery do you recommend for my specific case?
  2. What are the potential risks and complications associated with the surgery?
  3. What is the success rate of the surgery in terms of lowering intraocular pressure?
  4. What is the recovery process like after the surgery?
  5. Will I need to take any medications or make lifestyle changes post-surgery?
  6. How long will the effects of the surgery last?
  7. Are there any alternative treatments or procedures I should consider?
  8. How many times have you performed this type of surgery, and what is your success rate?
  9. Will I need to have follow-up appointments or additional treatments after the surgery?
  10. What can I expect in terms of vision improvement after the surgery?

Reference

Authors: Petrov SY, Vostrukhin SV, Aslamazova AE, Sherstneva LV. Journal: Vestn Oftalmol. 2016;132(3):96-102. doi: 10.17116/oftalma2016132396-102. PMID: 28635828