Barraquer Eye Hospital (Barcelona, Spain) is a world reference in glaucoma surgery.
Doctor Mª Isabel Canut, coordinator of the Glaucoma Department, is the Secretary General of the Spanish Glaucoma Society, the institution that promotes the research of this disease nationwide.
Professor Rafael Barraquer (glaucoma specialist) has been appointed in 2017 President of EVER (European Association for Vision and Eye Research).
Glaucoma affects the optic nerve causing an irreversible deterioration of it, with a resulting loss of vision. When glaucoma is diagnosed it must be treated without delay.
Glaucoma surgery (trabeculectomy or deep sclerectomy) manages to lower the pressure when using medication is not enough.
80% of the people who choose glaucoma surgery have their eye pressure reduced.
Barraquer Eye Hospital (Barcelona, Spain) : the best option for your glaucoma surgery.
FAQS about glaucoma surgery at Barraquer Eye Hospital (Barcelona, Spain):
What techniques are currently used for glaucoma surgery?
Glaucoma is a condition that affects the optic nerve causing an irreversible deterioration of it, with a resulting loss of vision. The most common cause is increased intraocular pressure. When glaucoma is diagnosed it must be treated without delay. If it is not treated in time or in the correct way, glaucoma can lead to blindness.
Before opting for glaucoma surgery, medical treatment is normally used, such as external application antihypertensive medication or eye drops. Another option is glaucoma treatment using laser. Currently there are different laser modalities depending on each case.
Depending on each patient, glaucoma specialists at Barraquer Eye Hospital will propose the most adequate option; medical treatment, laser treatment or surgical intervention.
Glaucoma surgery (trabeculectomy or deep sclerectomy) manages to lower the pressure when using medication is not enough. It permits us to slow down or stop the degenerative process that causes glaucoma. However, the patient should realize that the surgery will not recover the vision that has been lost because the optic nerve has been damaged and the nerve fibres can’t be regenerated.
Which glaucoma patients should turn to surgery?
In general, glaucoma surgery is decided on when the patient doesn’t respond to treatment with eye drops or has intolerance to them. On occasion laser treatment isn’t feasible or is inadequate. In the case that the glaucoma is at an advanced stage, the best option is surgery (trabeculectomy or deep sclerectomy) as it offers a more stable control of the eye pressure.
What are the benefits of glaucoma surgery?
The greatest benefit of glaucoma surgery (trabeculectomy or deep sclerectomy) is the normalization of the intraocular pressure which, if not controlled, leads to a progressive loss of vision. Furthermore, after glaucoma surgery, a high percentage of patients can dispense with their eye drop treatment which in turn improves the patient’s quality of life. If it is necessary, glaucoma surgery can be performed many times without considerable risk.
What risks are involved in glaucoma surgery?
Any surgery presents two main risks, infection and bleeding. In glaucoma surgery these complications are very unusual. The biggest risk involved in glaucoma surgery is wound healing. The ability of a healthy body to heal wounds means that the fistula created to drain the aqueous humor gets healed, and therefore the outlet that we have created closes causing the eye pressure to increase again.
This happens because the body tries to heal the new eye opening, as if it were dealing with a wound. This fast wound healing occurs more frequently in younger people because they have a stronger wound healing system.
The medication that impedes wound healing helps to slow down the healing of the opening. If it is necessary, it is possible to perform the filtration surgery for glaucoma several times on the same eye.
Another risk of glaucoma surgery would be excessive filtering and haemorrhaging.
What differences are there between glaucoma surgery using trabeculectomy and glaucoma surgery using deep sclerectomy?
Currently there are different types of glaucoma surgery depending on the kind of patient. It is important to do a personalized follow-up of each case and choose the surgery that best adapts to the characteristics of the patient. Glaucoma specialists at Barraquer Eye Hospital in Barcelona (Spain) will propose the most appropriate technique in each case. Factors that influence the decision as to the type of surgery to choose are the healing capacity of the patient, if they have previously suffered from other eye conditions or if they have been operated on in the past.
The most common technique for glaucoma surgery is trabeculectomy. It is a surgery called filtration, because the important thing to do is to create drainage or a fistula which allows the liquid (aqueous humor) to flow out of the eye.
Trabeculectomy is the most commonly used surgery but it has certain risks of complication that are not posed by non-penetrating deep sclerectomy, which goes down better with the patient.
This latter surgery creates a very thin membrane which lets the aqueous humor come out but in a more controlled way and with fewer complications. A complete opening is not made in the fistula which has been created and by not opening it up completely; sudden decompression is avoided. The postoperative period is much easier and recovery is faster.
In both cases, so that the results of the intervention are satisfactory, it is necessary that the newly created duct remains permeable and that the quantity of aqueous humor that drains from it is adequate. If the new duct closes with time because of the healing process, the intraocular pressure will increase again. On the other hand, if the aqueous humor flows out excessively through the new conduit, the intraocular pressure will go down too much, causing ocular hypotony.
What is the success rate for glaucoma surgery?
The majority of the studies carried out recently indicate that in older patients, filtration surgery for glaucoma (trabeculectomy or deep sclerectomy) is successful in about 70% to 90% of the cases, at least for one year.
Which surgical process does Barraquer Eye Hospital use for glaucoma surgery?
Preparation for the surgery
In general, filtration surgery for glaucoma (trabeculectomy or deep sclerectomy) is an outpatient procedure which doesn’t require spending the night in the hospital.
It is essential to check the good condition of coagulation before glaucoma surgery to avoid complications. The other requirements are the usual ones for surgery of this kind.
Is glaucoma surgery painful?
In most cases it is not painful. Surgery is usually done under local anaesthetic and with relaxing medicine. In general, an anaesthetic called intravenous sedation is used. Furthermore, an injection is given around or behind the eye to stop the eye moving. This injection is not painful. The patient will feel relaxed and drowsy and won’t feel any kind of pain during the surgery.
The immediate post-surgery period
Immediately after the glaucoma filtration surgery (trabeculectomy or deep sclerectomy) the eye will be red and irritated, and it’s possible that it will water more. Within a few days after the operation, specialists at Barraquer Eye Hospital will need to check the eye pressure. The doctor will also check for signs of infection or the increase of inflammation.
It is recommended that patients, for at least one week after the operation, try to avoid putting the eye in contact with water. It is possible to carry out most daily activities. However, it is important to avoid driving, reading, reclining and lifting heavy weights.
The first weeks
We can’t say that the surgery has been a success until a month after the intervention nor that all the scarring phenomena have been controlled. The risk of the fistula closing will still exist, and this even some years after the intervention, which is why the intraocular pressure must continue to be controlled despite the success of the intervention.
During various weeks after the surgery, you must put drops in your eyes to avoid infection and inflammation.
It is possible that during about six weeks after the surgery there will be some changes in the quality of your vision, such as blurred vision. After this time period, generally your vision will return to the same level as it was before the surgery.
On occasion, it is possible that vision will improve for patients who used to use pilocarpine. After stopping using pilocarpine drops, the pupil may return to its normal size, which would allow a greater amount of light into the eye.
After the surgery, it is possible that you will have to change your contact lenses or glasses. To avoid possible infections, specialists at Barraquer Eye Hospital will advise you about the way you should proceed.
International patients should anticipate a stay of about 10 days in Barcelona (Spain) for the postoperative tests. These visits and tests are completely free.
How much does glaucoma surgery cost?
Glaucoma surgery cost depends on many factors. We would be delighted to answer your query. Please, fill in this form. If you have any medical reports or examination results from other centres, we would appreciate it if you could send these tests to us by email so we can offer you the solution that best suits your needs.
You can be sure that this information will always be treated with the maximum confidentiality.
I am a foreign patient. Will the medical personnel at Barraquer speak my language?
Qualified personnel are placed at your disposal and they will advise you in your language and accompany you during all the hospital process. In case the doctor does not speak your language, a personal interpreter can accompany you throughout all your visits.
Can I have glaucoma in just one eye?
In the initial phase it is possible that glaucoma is only exhibited in one eye, but it is probable that it will end up affecting both of them, as it usually develops at different speeds in each eye.
Can glaucoma and cataracts be operated on at the same time?
In patients with closed-angle glaucoma and cataracts, cataract surgery can be performed at the same time as the glaucoma intervention; in this way, the patient doesn’t have to be operated on twice.
Can both eyes be operated on for glaucoma at the same time?
As with conventional surgery, laser surgery is used on only one eye at a time. In general, eye surgeries are done with a period of four to six weeks between one and the other.
How many days must I stay in Barraquer Hospital after glaucoma surgery?
In general, filtration surgery (trabeculectomy or deep sclerectomy) is an outpatient procedure which does not require spending the night in the hospital.
How much time must I stay in Barcelona after the intervention?
International patients should anticipate a stay of 10 days in Barcelona (Spain) for the postoperative tests. These visits and tests are completely free.
What alternatives do I have if in my case the prospects for the surgery are not good?
In patients with diabetes or neovascuar glaucoma, for those whose previous operation has bad prospects, drainage valves are usually chosen to be used. These are silicone tubes which communicate the interior of the eye with the exterior of it, through which the aqueous humor can drain out. This is reserved for severe cases, in those which previous interventions have not worked or those who have suffered retinal detachment. In these cases, valves give better results than conventional surgery because the eye structures are already very damaged.
In the cases in which the vision is very low and that the main objective is to reduce the discomfort and the intraocular pressure, but without the hope of improving the vision, diode laser is opted for. This alternative of diode laser is also valid when the conjunctiva or another part of the eye is much deteriorated and no other treatment can be used.
Does high pressure in the eye indicate that I have glaucoma?
Not necessarily. High pressure inside the eye means that you are at risk of developing glaucoma but it doesn’t mean that you have the disease. A person only has glaucoma if the optic nerve is damaged.
Furthermore, not everybody who has high pressure inside the eye develops glaucoma. Some people can tolerate high pressure inside the eyes better than others. Likewise, a certain level of pressure can be high for one person but normal for another.
Whether you develop glaucoma would depend on the level of pressure that your optic nerve can withstand without becoming damaged.
Can I develop glaucoma without having high pressure inside my eyes?
Yes, glaucoma can develop without an increase in the pressure inside the eyes. This type of glaucoma is called low-tension or normal-tension glaucoma. It is not as common as closed-angle glaucoma.
At what age does glaucoma usually manifest itself?
The risk of glaucoma manifesting itself is higher after 60 years of age but it is good to have check-ups as of 40 years old.
Best glaucoma specialists at Barraquer Eye Hospital (Barcelona, Spain)
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