Our Summary

This research paper discusses the connection between medical therapy, the health of the eye’s surface (known as the ocular surface or OS), and a type of eye surgery called filtration surgery (FS) that is often used to treat glaucoma. Long-term use of medications to lower eye pressure can harm the health of the OS, which can make glaucoma surgery more difficult and less effective. Changes to the OS can also affect how well the surgery works. Therefore, it’s important to improve the health of the OS before doing the surgery.

However, there’s no consensus on the best way to prepare patients and their eyes for surgery. This is largely because there aren’t any established guidelines, so doctors often have to rely on their own judgment and low-quality studies.

The paper reviews the risk factors that can lead to surgery failure, particularly those related to changes in the OS, and how an unhealthy OS can affect the body’s ability to absorb fluid from the eye after surgery. The authors discuss methods to improve the health of the OS before surgery, why a standard approach doesn’t exist, and future areas of intervention to maintain the health of the OS during glaucoma treatment.

Finally, based on the current evidence, they propose a pre-surgery plan that takes into account the main risk factors and treatment options to improve the health of the OS.

FAQs

  1. How does the health of the ocular surface impact the effectiveness of glaucoma surgery?
  2. Why is there no consensus on the best way to prepare patients for glaucoma surgery?
  3. What are the proposed pre-surgery plans for improving the health of the ocular surface before glaucoma surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about glaucoma surgery is to focus on improving the health of the eye’s surface before the surgery. This can help make the surgery more effective and reduce the risk of complications. It’s important to follow any recommendations provided by your doctor to optimize the health of your eyes before undergoing glaucoma surgery.

Suitable For

Patients who are typically recommended for glaucoma surgery are those who have not been able to adequately control their intraocular pressure (IOP) with medications or other treatments. These patients may have advanced glaucoma, rapidly progressing glaucoma, or have experienced significant side effects from their medications. Additionally, patients with certain types of glaucoma, such as angle-closure glaucoma or secondary glaucoma, may also be candidates for surgery.

In addition, patients who have a compromised ocular surface due to long-term use of glaucoma medications may also be recommended for surgery. Improving the health of the ocular surface before surgery can help enhance the success of the procedure and reduce the risk of complications.

Overall, the decision to recommend glaucoma surgery is individualized based on each patient’s specific condition, response to treatment, and overall eye health. It is important for patients to work closely with their eye care provider to determine the best course of action for managing their glaucoma and preserving their vision.

Timeline

Before glaucoma surgery, a patient may experience worsening vision, increased eye pressure, and difficulty seeing in low light. They may also experience side effects from glaucoma medications such as eye irritation, redness, and dry eyes.

After glaucoma surgery, a patient may experience improved vision, reduced eye pressure, and a decreased need for glaucoma medications. However, they may also experience temporary side effects such as redness, swelling, and discomfort in the eye. It may take several weeks for the eye to fully heal and for the patient to experience the full benefits of the surgery. Follow-up appointments with the eye surgeon are typically needed to monitor the healing process and ensure the success of the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about glaucoma surgery include:

  1. What are the risks and benefits of glaucoma surgery compared to continuing with medication therapy?
  2. How will my ocular surface health impact the success of the surgery?
  3. What steps can be taken to improve the health of my ocular surface before surgery?
  4. Are there any specific tests or evaluations that should be done before proceeding with surgery?
  5. What are the potential complications or side effects of glaucoma surgery?
  6. How long is the recovery process and what can I expect during that time?
  7. Will I still need to use glaucoma medications after surgery?
  8. How often will I need follow-up appointments after surgery?
  9. Are there any lifestyle changes or precautions I should take after surgery to ensure the best outcomes?
  10. What are the success rates of this particular type of surgery for my specific case of glaucoma?

Reference

Authors: Agnifili L, Sacchi M, Figus M, Posarelli C, Lizzio RAU, Nucci P, Mastropasqua L. Journal: Acta Ophthalmol. 2022 Nov;100(7):740-751. doi: 10.1111/aos.15098. Epub 2022 Jan 28. PMID: 35088941