Which Patients Should Have Glaucoma Surgery?
Trabeculectomy or deep sclerectomy can effectively lower eye pressure when medication is not enough, or you can’t tolerate them.
Indeed, if glaucoma eye drops cause you severe side effects like rapid heartbeat, high blood pressure, or impotence, you may want to give surgery a try.
On occasions, laser treatment is unsuccessful, unavailable, or contraindicated. Hence, in the case of advanced glaucoma, the best option is surgery (trabeculectomy or deep sclerectomy), as it offers more reliable and effective control of eye pressure.
Some patients need it right away as a first choice if their eye pressure is dangerously high and puts their vision at risk.
However, the patient should know that glaucoma surgery will not result in vision recovery. The damage to the optic nerve is irreversible, and the nerve fibers can’t be regenerated.
Ahmed Glaucoma Valve or Glaucoma Implant Surgery
Implantation of Ahmed glaucoma valve is a practical surgical approach to reduce intraocular pressure in glaucoma patients.
A few years ago, the use of this device was reserved for glaucoma refractory to multiple filtration surgical procedures. However, new research has encouraged its use also as a primary surgery for selected cases.
This surgery is used to treat several types of glaucoma, including congenital glaucoma, neovascular glaucoma, and glaucoma secondary to trauma.
Also, tube shunts have become really popular for use in younger patients whose more vigorous healing response can jeopardize the success of trabeculectomy.
Aqueous shunt devices (glaucoma implants) are artificial drainage devices with plastic microscopic tubes attached to a plastic reservoir.
The reservoir is placed right beneath the conjunctival tissue. The actual tube (attached to the reservoir) is placed inside the eye to create a new pathway for fluid to exit the eye. This tube helps extra fluid drain out of your eye, lowering your eye pressure.
The surgery usually takes between 1 to 2 hours.
Although the valve mechanism in the Ahmed device decreases the risk of postoperative hypotony-related complications, it does not avoid the need for a careful follow-up.
What Is the Success Rate for Glaucoma Surgery?
New research indicates 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.
Preparing for Surgery.
In general, trabeculectomy or deep sclerectomy is an outpatient procedure that doesn’t require overnight hospitalization.
It is essential to verify the coagulation status of the patient before surgery to avoid complications. In case of taking aspirin or blood thinners, they must be stopped a few days before surgery.
Is glaucoma surgery painful?
It is not painful. Surgery is usually done under local anaesthetic with additional intravenous sedation if needed.
Local anaesthesia will stop the eye muscles from moving. You will feel relaxed and drowsy and won’t feel any pain or discomfort during the surgery.
How Is the Recovery After Glaucoma Surgery?
The immediate post-surgery period
Immediately after the surgery, the eyes will be red, itchy, and watery.
Within a few days after the surgery, the specialists will need to check the eye pressure. The doctor will also check for signs of infection or inflammation.
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 for the first weeks.
The first month
We can’t say that the surgery has been a success until a month after the intervention.
The risk of the fistula closing will still exist, and even some years after the intervention, which is why the intraocular pressure must be closely monitored.
For several weeks, you must put drops in your eyes to avoid infection and inflammation.
About six weeks after the surgery, you may experience blurred vision. After this period, your vision will generally return to the same level as before the intervention.
It is possible that patients who used pilocarpine experience a partial visual recovery. 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, you may have to change your contact lenses or glasses prescription.
You will need about a month for a full recovery. Quicker recovery periods last about three weeks.
How Much Does Glaucoma Surgery Cost?
Glaucoma surgery cost depends on the performed technique (trabeculectomy or deep sclerectomy).
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FAQS about glaucoma surgery:
Can I have glaucoma in just one eye?
In the initial phase, glaucoma may be only present in one eye, but ultimately it will affect both of them. It usually develops at different speeds in each eye.
Can both eyes be operated on for glaucoma at the same time?
In general, eye surgeries are done with a period of four to six weeks between one eye and the other.
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 you have the disease. A person only has glaucoma if the optic nerve is 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 is higher after 60 years of age, but it is good to have check-ups as of 40 years old.
I am a foreign patient. Will the medical personnel at Barraquer speak my language?
Qualified personnel is placed at your disposal, and they will advise you in your language and accompany you during the hospital process. If the doctor does not speak your language, a personal interpreter can accompany you throughout all your visits.
How many days must I stay in Barraquer Eye Hospital after glaucoma surgery?
In general, trabeculectomy or deep sclerectomy is an outpatient procedure that 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.
Best glaucoma specialists at Barraquer Eye Hospital
External links – Bibliography
Efficacy of Ologen matrix implant in Ahmed Glaucoma Valve Implantation. Sastre-Ibáñez M, Cabarga C, Canut MI, Pérez-Bartolomé F, Urcelay-Segura JL. 2019 Feb 28
Anterior segment changes following intravitreal bevacizumab injection for treatment of neovascular glaucoma. Canut MI, Alvarez A, Nadal J, Abreu R, Abreu JA, Pulido JS.Clin Ophthalmol. 2011
Neovascular glaucoma treatment with extraction of anterior chamber fibrovascular tissue. Nadal J, Carreras E, Kudsieh B, Canut M.JAMA Ophthalmol. 2013 Aug
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