Glaucoma is a disease of the optic nerves. The resulting damage is not reversible. An increased intraocular pressure is usually responsible for this. If left untreated, the disease can lead to blindness. There are various options for treating glaucoma, including medications in drop form as well as laser therapies and surgical measures. Glaucoma surgery may be necessary if conservative treatment does not produce the desired results.
During glaucoma surgery, we create an artificial drain for the aqueous humor in the eye. This lowers the intraocular pressure, and further progression of the disease is prevented or at least slowed down. However, vision loss that is already present cannot be reversed. Early surgery can often stop further deterioration.
Glaucoma is a serious eye disease that occurs primarily in advanced age. In this disease, the outflow of aqueous humor in the eye is disturbed. The aqueous humor fills the anterior and posterior chambers of the eye. From here, it supplies nutrients to the structures in the eye that are not supplied with blood. The outflow occurs via the so-called chamber angles, where the aqueous humor is reabsorbed and subsequently re-enters the bloodstream.
In glaucoma, this mechanism is disturbed. There is an imbalance between the production and outflow of aqueous humor. As a result, intraocular pressure rises and damage occurs to the optic nerve and retinal cells.
Glaucoma is usually noticed late, as vision loss can develop insidiously over many years. Also pain does not occur as a rule. The only exception is the so-called glaucoma attack, in which the intraocular pressure rises sharply within a very short time. The glaucoma attack is a medical emergency and must be treated immediately by an ophthalmologist.
In most patients, however, the intraocular pressure does not rise abruptly, but the damage to the optic nerve progresses gradually. The first signs of glaucoma include visual field loss and colored rings around light sources. If left untreated, the disease progresses and eventually leads to blindness.
Glaucoma is a classic disease of old age. With increasing age, the risk of developing glaucoma increases. The increase in pressure in the eye is then usually due to the outflow paths of the aqueous humor being blocked by deposits. The relationship between production and outflow of the aqueous humor can also become unbalanced due to age.
Other causes of increased intraocular pressure are medications and a family history. People with severe defective vision as well as past injuries or severe inflammations of the eye also have an increased risk of the disease. Furthermore, circulatory disorders seem to favor a damage of the nerve cells. On average, diabetics are also more likely to develop glaucoma.
We have several options for glaucoma therapy. Before glaucoma surgery is considered, it can first be treated with medication. The goal of the therapy is to lower the intraocular pressure and stabilize it in the long term.
Furthermore, the intraocular pressure can be lowered by using different laser techniques. Here, the outflow of the aqueous humor is improved by punctual laser treatment. However, the success of the treatment is often limited in duration.
Three methods are available for the laser treatment of glaucoma: Argon laser treatment improves aqueous humor outflow by creating laser scars. The neodymium YAG laser creates a connection between the posterior chamber of the eye, where aqueous humor is produced, and the anterior chamber of the eye, where aqueous humor drains. This can prevent the development of a glaucoma attack. Cyclophotocoagulation decreases the formation of aqueous humor and lowers intraocular pressure.
If medication and laser treatment do not lead to the desired success, the only remaining option is surgery. During the short microsurgical procedure, an artificial drain is created for the aqueous humor. This reduces the intraocular pressure. This is usually followed by anti-inflammatory drip therapy for 6 - 12 weeks, depending on the procedure. This is to prevent scarring of the treatment areas and ensure adequate drainage of the aqueous humor.
Surgery is recommended when the progress of the disease cannot be stopped despite therapy with eye drops or laser procedures. Both the type of glaucoma and the patient's individual risk profile are taken into account. Once damage to the optic nerve has occurred, it cannot be reversed in retrospect. Therefore, if in doubt, glaucoma surgery should be performed as soon as possible.
If you have been diagnosed with glaucoma, glaucoma surgery is usually already preceded by medication. Even if your ophthalmologist already knows your medical records, he will take the time for a detailed preliminary consultation. He will inquire about which medications you take regularly, since certain preparations (e.g. blood thinners) must be temporarily discontinued. He then selects the appropriate form of anesthesia together with you. As a rule, glaucoma surgery can be performed under local anesthesia. Whether an inpatient or outpatient procedure is necessary depends on the surgical procedure.
Glaucoma surgery takes about 15-90 minutes, depending on the amount of work involved. If both eyes are affected, the more severely affected one is usually operated on and the second one a few weeks later. This way you are not too restricted in your everyday life.
The goal of glaucoma surgery is to promote the outflow of aqueous humor. For this purpose, the surgeon opens the conjunctiva in filtering surgery and creates a new channel for the aqueous humor underneath. To counteract the tendency to scarring, anti-inflammatory eye drops are used in the following weeks. Today, there is often the possibility of minimally invasive procedures. These procedures often work with small stents in the chamber angle and in combination with cataract surgery.
Following glaucoma surgery, it is important that you take it easy on yourself for a few weeks. You should use the prescribed eye drops conscientiously, as the success of the treatment depends on this. It is also important that you do not rub your eyes. If you experience any discomfort after glaucoma surgery, such as loss of visual acuity, bleeding or pain, do not hesitate to contact your treating ophthalmologist immediately.
Like any surgery, glaucoma surgery carries certain risks. Complications such as wound healing problems, infections or bleeding can never be completely ruled out. Your attending physician will inform you in detail about possible side effects and how they can be avoided before glaucoma surgery.
The goal of glaucoma surgery is to reduce intraocular pressure in the long term. However, damage to the optic nerve that has already occurred cannot be reversed. Therefore, no improvement in vision can be expected after glaucoma surgery. If the current condition can be maintained and your vision does not deteriorate further, glaucoma surgery can be considered successful.
Cataract and glaucoma can be treated in a combined surgery. You can find more information about this under cataract surgery.