Ophthalmology

Glaucoma surgery

Therapy glaucoma

The aim of glaucoma therapy must be the individual optimal adjustment of the intraocular pressure. This means that the pressure has to be reduced. This can be done using three different methods:

Eye drops (medication)
Laser treatment
surgery

Eye drop:
There are several groups of drugs available in treating glaucoma. The following table gives a brief overview of the substances and their effects.

Beta blockers: The aqueous humor production is reduced.

Sympathomimetics: Also reduction in aqueous humor production

Carbonic anhydrase inhibitors: Decrease in aqueous humor production

Prostaglandin derivatives: Improvement of uveoscleral outflow (see above)

Parasympathomimetics: Improvement of the outflow of aqueous humor through increased muscle contraction and the resulting opening of the chamber angle

Which of the eye drop are considered by the ophthalmologist. In addition to the desired effect, the side effects and other diseases that may be influenced by the drug must also be considered.
Typical side effects of Parasympathomimetics are for example entering Vision deterioration, especially in older people with pre-existing lens opacity (cataract). Caution is also required with the Beta blockers required. They can worsen an asthma or Heart rhythm disorders aggravate.

Some of them have an antihypertensive effect, which is discussed in the therapy high blood pressure is desirable.

Green star laser treatment

There are two ways to treat glaucoma with laser therapy. One variant is called trabeculoplasty.
80-100 “laser shots” are fired into the area of the chamber angle, thereby improving the outflow of the aqueous humor. The other variant is the so-called cyclophotocoagulation, in which the ciliary epithelium, i.e. the region in the eye that produces the aqueous humor, is targeted. The aim is to partially destroy (Desolation) and thus to reduce the aqueous humor production.

Glaucoma operation

In order to improve the aqueous humor outflow, several surgical procedures have been developed for glaucoma. Ultimately, however, you always create an additional, artificial drain for the aqueous humor. Most procedures aim to create a rectangular opening (trabeculectomy) or a round opening (goniotrepanation) in the anterior chamber of the eye through which the aqueous humor can then be absorbed by veins and lymphatic vessels.
These so-called filtration operations are often more effective than drug therapy. On the other hand, they naturally also involve the usual risks that an operation entails. Inflammation, unpredictable bleeding, and other damage can occur. As a rule, however, these risks are rather low. However, postoperative wound healing disorders occur much more frequently (around a quarter of cases). These lead to scarring with subsequent closure of the artificial opening and again deteriorated aqueous humor drainage.
The result is increasing intraocular pressure.

Other similar but not so deeply penetrating (invasive) surgical procedures are the deep sclerectomy and the Viscocanalostomy.
In the deep sclerectomy Leave a wafer-thin layer of Schlemm's canal over the artificially created opening to prevent excessive drainage of the aqueous humor.
In the Viscocanalostomy the Schlemm Canal is widened with the aim of restoring the normal drainage path. However, these procedures are usually not as effective as the filtration operations.

Of the acute attack of glaucoma is a emergency. First of all, the intraocular pressure should be lowered as quickly as possible. This is achieved using drugs (see above). An iridectomy can be performed surgically. With iridectomy, either surgically or with a laser, a gap is made in the Iris (iris) created. This allows the aqueous humor to flow well from the posterior chamber into the anterior chamber and then drain into the aqueous humor.

The congenital glaucoma is always treated with an operation. One leads one Goniotomy by. This is an operation in which remnants of the embryonic tissue in the corner of the chamber are cut out. Then Schlemm's canal is free again and the aqueous humor can drain away. In contrast to adults, it is possible in newborns and small children that a dent in the papilla partially regresses after the surgical treatment.

Therapy at Secondary glaucoma depends on the underlying disease (e.g. Diabetes mellitus). The treatment options for the eye are essentially the ones described above. The main focus is always on the underlying disease and its treatment (e.g. in the case of diabetes, the correct setting of sugar and fat levels).