Our Summary

This research paper is about managing glaucoma, a condition that increases pressure in the eye and can lead to blindness. The usual treatment involves a step-by-step process beginning with medication, followed by laser surgery, and finally a more intensive type of surgery. However, there are issues with this approach, including side effects from the medication and the fact that patients often don’t stick to the treatment plan. Also, the surgeries can have complications.

Because of these problems, the researchers are looking at new methods. One promising option is micro-invasive glaucoma surgery (MIGS), which uses tiny implants (microstents) to help reduce the need for medication and delay more invasive surgery. The paper provides a detailed look at the different types of these implants and discusses how effective and safe they are based on the available data.

FAQs

  1. What is the common approach in the management of glaucoma therapy?
  2. What are the benefits of Micro-invasive glaucoma surgery (MIGS) and the use of microstents?
  3. What are the different types of trabecular implants mentioned in the review and how effective and safe are they?

Doctor’s Tip

One helpful tip a doctor might tell a patient about glaucoma surgery is to follow post-operative instructions carefully, including using any prescribed eye drops as directed and attending follow-up appointments to monitor progress and ensure proper healing. It is also important to avoid strenuous activities that could increase intraocular pressure and potentially impact the success of the surgery. Additionally, be sure to communicate any changes or concerns with your doctor promptly to address any issues that may arise.

Suitable For

Glaucoma surgery is typically recommended for patients who have been unable to effectively manage their intraocular pressure with medication or laser surgery. Patients who have glaucoma that is progressing despite treatment, those who are experiencing significant side effects from glaucoma medications, or those who have difficulty adhering to their medication regimen may be candidates for glaucoma surgery. Additionally, patients who have advanced or severe glaucoma that is at risk of causing vision loss may also be recommended for surgery. Micro-invasive glaucoma surgery, such as trabecular implants, may be particularly beneficial for patients who are looking to reduce their medication burden and delay the need for more invasive filtration surgery.

Timeline

  • Before glaucoma surgery:
  1. Patient is diagnosed with glaucoma through a comprehensive eye exam that includes measuring intraocular pressure, assessing the optic nerve, and testing visual field.
  2. Patient is prescribed medications to lower intraocular pressure and prevent further damage to the optic nerve.
  3. Patient may undergo laser surgery, such as selective laser trabeculoplasty (SLT), as a treatment option before considering more invasive surgical procedures.
  4. If medications and laser surgery are not effective in managing intraocular pressure, patient may be recommended for filtration surgery, such as trabeculectomy or tube shunt surgery.
  • After glaucoma surgery:
  1. Patient may experience temporary discomfort, redness, and blurry vision following surgery.
  2. Patient will need to continue using prescribed eye drops and medications to prevent infection and manage inflammation.
  3. Patient will have follow-up appointments with their ophthalmologist to monitor intraocular pressure and healing progress.
  4. Patient may need to make lifestyle adjustments, such as avoiding heavy lifting or strenuous activities, to prevent complications during the healing period.
  5. Over time, patient should experience improved intraocular pressure control and preservation of vision with the successful outcome of the surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with glaucoma surgery?
  2. How long is the recovery period after glaucoma surgery?
  3. Will I still need to use glaucoma medications after surgery?
  4. How likely is it that the surgery will successfully lower my intraocular pressure?
  5. What is the long-term success rate of the specific type of glaucoma surgery being recommended?
  6. Are there any lifestyle changes I should make before or after surgery to improve the outcome?
  7. How often will I need to follow up with you after the surgery?
  8. What should I do if I experience any unusual symptoms or side effects after the surgery?
  9. Are there any alternative treatment options to consider before moving forward with surgery?
  10. How experienced are you in performing this type of glaucoma surgery?

Reference

Authors: Jünemann AGM, Rejdak R, Hohberger B. Journal: Ophthalmologe. 2018 May;115(5):363-369. doi: 10.1007/s00347-018-0689-x. PMID: 29671050