EYEDROPS –After instilling any antiglaucoma eyedrop , close your eyes for 1-2 mins & press index finger lightlyagainst inferior nasal corner to close tear duct which drains into nose . This is to maximise theamount of drug absorbed in the eye & minimize absorption into bloodstream .
PILLS –If IOP is not controlled with eyedrops , pills are used in addition to eyedrops . pills need to beadministered 2 – 4 times /day as requirement . They do have systemic side effects , hence priorsystemic evaluation & history of any pre existing illness required before administration of pills .
PROCEDURES –When desired results are not achieved with medications or patient experiences intolerableside effects , then surgical correction is needed .*LASER SURGERY –It is an intermediate step between drugs & traditional surgery (TRABECULOPLASTY ).It is used totreat OPEN ANGLE GLAUCOMA1)ARGON LASER TRABECULOPLASTY –Treats trabecular meshwork of the eye increasing aqueous drainage outflow , thereby decreasingintraocular pressure2)SELECTIVE LASER TRABECULOPLASTY –Newer laser which uses low energy , selects part of trabecular meshwork & leaves few partsintact,unlike other types , it can be safely repeated .
*LASER PERIPHERAL IRIDOTOMY –It is used to treat ANGLE CLOSURE GLAUCOMA .Opening is madethrough iris , allowing aqueous fluid to flow from behind the iris , directly into Anterior chamber ofthe eye , thereby fluid bypasses its normal route .
*CYCLOABLATION –Transcleral cyclophotocoagulation uses a laser to direct energy through outersclera of the eye to reach & destroy portions of ciliary processes without damaging overlying tissuesWith Endoscopic cyclophotocoagulation instrument is placed inside the eye , through surgicalincision , so laser energy is applied directly to ciliary body .
*TRADITIONAL SURGERY –Conventional surgery TRABECULECTOMY is preferred when medication &laser treatment do not adequately lower Intraocular pressure . It is used in Open as well as Angleclosure glaucoma . Surgeon creates passage in sclera for draining excess eye fluid.Flap is created toallow the fluid to escape , but does not deflate the eyeball . On superior surface of eyeball overlimbus , small bubblle of fluid called BLEB is created , which ios a sign that fluid is draining into spacebetween sclera & conjunctiva . Ocassionally the BLEB closes & IOP rises since the body tries to healthe opening targeting it as injury.Hence many surgeons use antifibrotic agents like Mitomycin C or5 FU during surgery to prevent scarring .50% patints do not require Antiglaucoma medication forsignificant length of time post surgery .
* DRAINAGE IMPLANT SURGERY – Several types of drainage devices are available which have asimilar design consisting of small silicone tube that extends into anterior chamber of the eye .Thetube is connected to one or more plates which are sutured to surface of the eye .Fluid is collected onplate & absorbed by tissue in eye preferred in patients whose pressure is not controlled bytrabeculectomy or who have previos scarring
* NON PENETRATING SURGERIES -It is a promising surgery in future, since it minimizes postoperative complication , lowers risk of infection as it does not enter Anterior chamber ., but itrequires greater surgical Acument. Furthermore longterm studies are neededto assess theseprocedures & to determine their role in clinical management of glaucoma patients .
*PROMISING SURGICAL ALTERNATIVES –1)EXPRESS MINIGLAUCOMA SHUNT -stainless steel like device inserted into Anterior chamber of eye& placed under scleral flap .It offers an alternative to either repeating Trabeculectomy or placing amore extensive silicone tube shunt in patients whose IOP is higher than the optic nerve can tolerate2) TRABECTOME – New probe like device that is inserted into anterior chamber through cornea . Itdelivers thermal energy to trabecular meshwork , reducing resistance to outflow of aqueous humour, resulting in reduction of IOP3) CANALOPLASTY – Recent advancement in non penetrating surgery. It is compared to an ocularversion of Angioplasty in which physician uses extremely fine catheter to clear drainage canal
For more information take appointment today itself with Dada Laser Eye Institute !
