Exclusive glaucoma surgery, 11 possible quistions by Best Explain:

Exclusive glaucoma surgery, 11 possible quistions by Best Explain!

glaucoma surgery

Glaucoma is a progressive optic neuropathy that causes an irreversible deterioration of the visual field that can progress to blindness. The main risk factor is elevated intraocular pressure.

Anglo-Saxons nicknamed glaucoma "the silent thief of sight" because of its insidious character.

Question 1
 - What is glaucoma? 

Glaucoma is a progressive and irreversible attack of the optic nerve. This affects holes in the field of vision that can extend to blindness. The main risk factor for glaucoma is an intraocular pressure (also called ocular pressure) that is too high.

Question 2
- Why is the pressure rising?

The eye is a soft structure like a rubber ball. It is the internal production of liquid (the aqueous humor) which, like the air in the balloon, gives it its spherical shape. This liquid comes out of the eye through a filter called trabeculae. When the liquid flows easily, the pressure in the eye (also called eye pressure) remains low. On the other hand, if the trabecular becomes less permeable, or if the iris leans against it, the liquid emerges less easily from the eye, and the pressure may become too high.

In open-angle glaucoma, the trabecular (red in the drawing) becomes less permeable: the fluid accumulates in the eye and the pressure rises.

glaucoma surgery with open angle, Paris

In glaucoma by the closure of the angle, it is the iris which obstructs the passage to the trabeculae.

Read more here.

Closure of the angle, glaucoma, Paris

Question 3 What are the effects of too high a pressure?

Intraocular pressure too high causes the optical fibers to progressively lose where they meet to form the optic nerve.

Holes then form insidiously in our visual field.

But this notion of pressure too high varies according to individuals: one can have a very high intraocular pressure but also have a very "strong" optic nerve, and thus no glaucoma. Conversely, some patients have a "normal" pressure but a very fragile optic nerve that does not withstand this pressure and is damaged: this is called glaucoma at normal pressure.

 Question 4"What sign can she tell me?"

No ! Strictly none! This seems the most bizarre to all patients.

When one speaks of too high pressure in the eye, one imagines an eye ready to explode, and after the statement of the diagnosis one often feels like having the eye heavy, inflated ... In fact, outside Rare cases where the pressure rises enormously and in a very brutal way, one feels nothing. Since the pressure is very progressive, it is strictly painless.

In addition, glaucoma, for a very long time, damages the eye without giving any visual sign: the death of optical fibers causes holes in the field of vision, but our brain masks these areas. It is only when these areas invade almost the whole of the field of vision that one feels an embarrassment, and in these cases, one is close to blindness.

To understand this phenomenon of masking, I propose to you to discover a hole in your visual field, that you had never however noticed. It corresponds to the emergence of the optic nerve in the eye: at this site, there are no sensors, it is the "blind spot".

Apart from a very specific case, acute glaucoma. The abrupt and complete closure of the iridocorneal angle causes a large and sudden rise in intraocular pressure. The symptoms of acute glaucoma are noisy: the eye is red and painful. Pains can radiate around the eye and towards the head. They are sometimes accompanied by nausea and vomiting. Like all red and painful eyes, this is an ophthalmological emergency.

Caution: Angle-closure glaucoma is not all acute glaucoma.

Glaucoma by closing the angle are generally insidious and painless because the angle closes gradually and incompletely. Only a small percentage of eyes with a risk of closure

 Question 5- How to calculate my risk of glaucoma surgery?

glaucoma surgery

In France, about 1 million people have glaucoma, half of which are unaware of their disease. Some factors increase the risk of being reached. Two are essential: the existence of glaucoma in the family and age. After 45 years, the risk of having double glaucoma every 10 years.

Question 6- How is the diagnosis of glaucoma?

Several elements can alert the ophthalmologist. Key players include:

Intraocular pressure, optic nerve head appearance, glaucoma in your family, age, ethnicity (black Africa or the West Indies), myopia.

Angle examination allows the distinction between open-angle glaucoma and closed-angle glaucoma. Even in the absence of proven glaucoma, it is always important to look for a risk of closure that can expose to glaucoma at a distance.

Other elements may also be involved, such as the thickness of the cornea (see pachymetry).

Further examinations will allow the slightest doubt to seek a glaucoma-related condition. These are the visual field and the structural examinations.

If these examinations do not show glaucomatous involvement, regular monitoring is carried out. The first examinations carried out to make it possible to establish a baseline. If a change in these examinations occurs, this will confirm the diagnosis of glaucoma. Glaucoma is indeed a progressive optical neuropathy: to prove a progression makes it possible to affirm the diagnosis of glaucoma.

Question 7- What is visual field examination?

When we look at the road while driving, if a bike appears on our right, we perceive it immediately, long before it is before us. We perceive it as soon as it enters our field of vision. Glaucoma does not diminish (except very late) our visual acuity, but it diminishes our ability to see on the side: little by little holes appear in our field of vision. The purpose of the examination called "visual field" is to map these holes ("scotomas").

It is a rather tedious examination, but it gives irreplaceable information.

Normal visual field, Dr. Jacques Laloum, glaucoma, ParisPerimeter Humphrey, Glaucoma, Paris

 Question 8- What are the other exams?

The other examinations look for changes in the structure of the optical fibers and the head of the optic nerve. The most common examination is the OCT. It sometimes allows confirming the diagnosis of glaucoma while the field of vision is still normal. He participates, with the examination of the visual field, to the surveillance of the glaucomatous affection.

OCT examination for the detection and follow-up of glaucoma, ParisOCT GCC glaucoma, Dr. Jacques Laloum, Paris

See OCT, GDx, HRT.

 Question 9- What is the treatment of glaucoma surgery?

In the case of a significant risk of glaucoma, or certain glaucoma, treatment is instituted. Its purpose is to slow as much as possible the loss of optical fibers, and thus preserve vision. The issue is important because the loss of optical fibers is irreversible. Depending on the severity and type of glaucoma, there are different types of treatments that have proven effective: eye drops, laser, and surgery. They all act by lowering intraocular pressure.

Eye drops to lower the intraocular pressure by decreasing the secretion of aqueous humor or facilitating its exit from the eye.

The effect of the eye drops ceases after a few hours. The drops should, therefore, be taken very regularly.

The drop-down table below gives you direct access to the product sheets of all eye drops.

Factsheets

Eye drops

• ALPHAGAN 0.2%

• AZARGA

• AZOPT

• BETAGAN 0.5%

• BETAGAN 0.5% single-dose

• BUTANOL 0.6%

• BETOPTIC 0.25% susp opht

• BETOPTIC 0.25% susp ophth unidose

• BETOPTIC 0.5%

• BRIMONIDINE CHAUVIN

• BRIMONIDINE EG

• BRIMONIDINE MYLAN

• BRIMONIDINE RATIOPHARM

• BRIMONIDINE SANDOZ

• BRIMONIDINE TEVA

• CARTEL 1%

• CARTEL 2%

• CARTEL LP 1% Unidos

• CARTEL LP 1% LP

• CARTEL LP 2% LP single-dose

• CARTEL LP 2% LP

• COMBIGAN

• COSOPT

• COSOPT single-dose

• DORZOLAMIDE ACTAVIS

• DORZOLAMIDE BIOGARAN

• DORZOLAMIDE EG

• DORZOLAMIDE MYLAN

• DORZOLAMIDE TEVA

• DORZOLAMIDE / TIMOLOL Biogaran

• DORZOLAMIDE / TIMOLOL MYLAN

• DORZOLAMIDE / TIMOLOL SANDOZ

• DORZOLAMIDE / TIMOLOL TEVA

• DUALKOPT

• DUOTRAV

• GANFORT

• GANFORT Unidos

• GELTIM LP 1 mg / g single-dose gel

• IOPIDINE 0.5%

• IOPIDINE 1% single-dose

• ISOPTO-PILOCARPINE 1% eye drops

• ISOPTO-PILOCARPINE 2% eye drops

• LATANOPROST Actavis

• LATANOPROST Arrow

• LATANOPROST Biogaran

• LATANOPROST Chauvin

• LATANOPROST EG

• LATANOPROST Mylan

• LATANOPROST Ranbaxy

• LATANOPROST Sandoz

• LATANOPROST Teva

• LATANOPROST Zydus

• LATANOPROST / TIMOLOL Arrow

• LATANOPROST / TIMOLOL Biogaran

• LATANOPROST / TIMOLOL EG

• LATANOPROST / TIMOLOL Mylan

• LATANOPROST / TIMOLOL Pfizer

• LATANOPROST / TIMOLOL Sandoz

• LATANOPROST / TIMOLOL Teva

• LATANOPROST / TIMOLOL Zentiva

• LATANOPROST / TIMOLOL Zydus

• LUMIGAN 0.1 mg / ml

• LUMIGAN 0.3 mg / ml

• MONOPROST

• NYOGEL LP 0.1% ophthalmic gel

• NYOLOL 0.25%

• NYOLOL 0.5%

• OPHTIM 0.25% single-dose

• OPHTIM 0.5% single-dose

• PILO 2% eye drops

• PILOCARPINE FAURE 1% college sol

• PILOCARPINE FAURE 2% eye drops

• SIMBRINZA

• TIMABAK 0.25%

• TIMABAK 0.5%

• TIMOCOMOD 0.25%

• TIMOCOMOD 0.5%

• TIMOLOL ALCON 0.5%

• TIMOLOL SANDOZ 0.10%

• TIMOLOL SANDOZ 0.25%

• TIMOLOL SANDOZ 0.50%

• TIMOLOL TEVA 0.25%

• TIMOLOL TEVA 0.5%

• TIMOPTOL 0.25%

• TIMOPTOL 0.5%

• TIMOPTOL LP 0.25%

• TIMOPTOL LP 0.5%

• TRAVATAN 40 μg / ml

• TRUSOPT

• XALACOM

• XALATAN 0.005%

Some drugs are intended to improve circulation in the optic nerve or to protect the neurons. None has proven its effectiveness, although these routes are very promising.

The laser called trabeculoplasty acts by improving the permeability of the trabeculae.

Filtering surgery consists in establishing a derivation of the aqueous humor to get it out of the eye. It is considered if, despite previous treatments, intraocular pressure remains high and glaucoma continues to evolve, resulting in a deterioration of the visual field.

If there is a risk of glaucoma by the closure of the angle, the first gesture is to make a small hole in the iris (see iridotomy). In the case of angle closure glaucoma, first-line treatment is no longer iridotomy but lens surgery (results of the EAGLE study published in October 2016).

Question 10

- glaucoma surgery: who? when? how?

In rare cases, the medical (and possibly laser) treatment does not make it possible to lower the intraocular pressure sufficiently. This means that the optical fibers continue to disappear at a higher than normal speed. If the fiber optic reserve is sufficient to ensure that future losses do not result in visual impairment for the patient, we can wait. Otherwise, surgery should be considered.

Its purpose is to lower the intraocular pressure, lowering the peaks, and decreasing fluctuations.

The principle of filter surgery is to create an internal derivation of the aqueous humor. The liquid comes out of the eye to go under the conjunctiva which covers the sclera. However, the release of liquid does not occur directly under the conjunctiva: the construction of a scleral flap makes it possible to obtain a kind of door.

There are two types of filter surgery, depending on whether or not a part of the natural eye filter is left: trabeculectomy and non-perforating splenectomy.

In the operation called non-perforating splenectomy, the orifice created to allow the evacuation of the aqueous humor is not complete: an external non-perforating trabeculectomy is performed, that is to say, l The innermost portion of the trabecular is left in place. The pressure reduction obtained is statistically a little less important in the long term than in surgery called trabeculectomy (perforating), but the risks of complications related to immediate sequences at too low a pressure are avoided.

The surgery called trabeculectomy consists of obtaining a complete perforation.

To prevent the iris from becoming attached to the orifice created and preventing the release of the aqueous humor, the surgeon makes a small hole in the iris (iridectomy).

The scleral flap plays a very important role in the trabeculectomy: sutures make it possible to control the opening of this small door in order to limit the output flow rate of the aqueous humor. This setting can be continued even after the operation. Some sutures may be removed or cut by laser several days after surgery.

The healing of the conjunctiva plays a crucial role in the aftermath of the filtering surgeries: excessive cicatrization blocks the release of aqueous humor. This is why we often use, during and after the operation, products that stop this healing.

Glaucoma surgery, glaucoma surgery, Dr. Jacques Laloum, Paris

Click on the image to see the video

New types of glaucoma surgery are currently being evaluated. A new type of surgery has recently emerged: micro-invasive surgery, which involves implanting microscopic drains inside the eye. Three devices are mainly studied:

- iStent® which derives the aqueous humor from the anterior chamber to the Schlemm canal,

- Cypass® which derives the aqueous humor towards the viral space located between the sclera and the choroid: the suprachoroidal space

- Xen-Gel® which drives the aqueous humor towards the subconjunctival space.

Micro-invasive glaucoma surgery (MIGS) is defined as the speed and relative safety of surgery compared with conventional surgery. These surgeries have, moreover, as a common feature the absence conjunctival at first: the devices are introduced into the anterior chamber of the eye during the cataract surgery. The integrity of the conjunctiva thus always permits second-line filter surgery. The best indications for these surgeries are mild to moderate glaucoma surgery.

Aside from this, the canaloplasty consists in introducing a thread into the canal of Schlemm. This wire is then tensioned and knotted, in turn tensioning the internal face of the channel, which increases its permeability.

The special case of refractory glaucoma (these glaucomas are defined by their resistance to conventional filter surgery) is discussed in a special chapter.

Question 11
- I have glaucoma: should I worry? 

Glaucoma is the second leading cause of blindness in developed countries (after AMD) and the leading cause of absolute blindness. But in the vast majority of cases, glaucoma is well cured. The difficulty is that it is a chronic condition that requires treatment and monitoring for life. The temptation may be great to interrupt his treatment, the more so since no consequences are perceived for a long time. Never suspend treatment and never stop monitoring is an essential condition to avoid the onset of visual impairment.

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About Dr - Lisa Adam

D.R: Lisa AdamMaster and assistant professor in the specialty of eye diseases and a researcher at the Academy of Specialized in eye diseases liked that I join all visitors and friends some of my knowledge humble in my blog glaucoma laser treatment intent to deliver information the greatest possible who suffer this disease.