When medications do not achieve the desired results, or have intolerable side effects, your ophthalmologist may suggest surgery. Here are some of the options available which have good results depending on the desired IOP reduction.
SLT is a newer laser that uses very low levels of energy. It is termed “selective” since it leaves portions of the trabecular meshwork intact. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated. Some authors have reported that a second repeat application of SLT or SLT after prior ALT is effective at lowering IOP.
The Ex-PRESS mini shunt is a relatively new device,available in USA since 2002. Over 12,000 implantations have been performed worldwide. It is a straightforward procedure, in which you divert the fluid through an extremely small tube to the outside of the eye. You neither cutsclera, nor iris. 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.
The Ex-PRESS mini glaucoma shunt provides effective longterm control of intraocular pressure, with a success rate of about 94% 2. Itcan be done following cataract surgery.
The Ex-PRESS has an equally effective intraocular pressurecontrol compared with trabeculectomy, but is safer than trabeculectomy in theshort term 3.
In most cases, patients virtually eliminate their need forglaucoma eye drops after Ex-PRESS surgery.
iStent is the smallest medical device ever approved by theFDA. It is placed in your eye during cataract surgery and is so small that youwon’t be able to see or feel it after the procedure is over. iStent is designedto create a permanent opening in your trabecular meshwork, and works continuouslyto improve the outflow of fluid from your eyes to help control eye pressure.
For patients with combined cataract and open-angle glaucoma,iStent reduces introcular pressure (IOP) by improving aqueous humor outflow.Inserted through a 1.5-mm corneal incision, iStent is the only FDA-approveddevice for the treatment of mild to moderate open-angle glaucoma.
The XEN Gel Stent surgery is an outpatient procedure
The XEN Gel Stent will be positioned carefully in your eye. It should start working to help reduce your eye pressure. Individual results may vary
Your doctor will schedule follow-up appointments to review your progress and determine your need for eye drops
The following resources can provide you with additional information about glaucoma:
The Glaucoma Foundation (TGF)
Glaucoma Research Foundation (GRF)
GRF Gleams Newsletter
Glaucoma Service Foundation to Prevent Blindness
National Eye Institute
New York Glaucoma Research Institute (NYGRI)