Discover Glaucoma surgery: Symptoms, Prevention, Treatment!.
Glaucoma is a serious condition in the eye that can lead to total blindness. It is characterized essentially by an increase in intraocular pressure, which in the absence of treatment can cause irreversible damage to the optic nerve. It occurs most often in adults over forty years of age, but it can also occur in children and young adolescents in its congenital form. There are many different types of glaucoma, the most common being chronic glaucoma and acute glaucoma.
1- Chronic single Glaucoma surgery:
Chronic single glaucoma Symptoms
Simple chronic glaucoma - the most common form of the disease - acts like a discreet burglar it "steals" the vision surreptitiously. Indeed, there are no warning signs at a sufficiently early stage of the disease, and when the loss of visual acuity is finally noticed, it is often already too late. The only way to detect glaucoma early is to perform an ophthalmologic examination including a measurement of ocular tension and gonioscopy (examination to determine whether the angle between the iris and the cornea is open for l Or aqueous humor evacuation, or closed). It is possible to have glaucoma while having a normal eye strain during the consultation: the taking of tension alone is therefore not sufficient to make a diagnosis, and the ophthalmologist may prescribe additional tests. One of the most common tests is a tonometer measuring the tension and pressure inside the eyeball. The tumor, when performed, resembles an electrocardiogram and helps the physician determine the presence of the disease.
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Later symptoms are characterized by the perception of colorful halos around electric lights, a hard eyeball like a stone, the appearance of blind angles, narrowing of the visual field and decreased night vision.
Chronic single Glaucoma surgery Treatment:
Installation of mystic (pilocarpine for example) favoring the evacuation of the aqueous humor and thus reducing the intraocular pressure. Constant medical surveillance is necessary to determine the course of the disease. A visual field examination should be performed at least once a year to verify the adequacy of the treatment and prevent lateral vision degradation. When medical treatment becomes insufficient, surgery is required, such as iridectomy, which involves sectioning a portion of the iris to widen the escape routes.
Chronic single Glaucoma surgery Prevention:
The best prevention is to periodically carry out a complete ophthalmological examination beyond forty years. (See Part Three, Precursor signs, Glaucoma 23a and 23b.)
Prognosis: Generally favorable if the disease is detected early enough.
2 - Acute glaucoma:
Danger: Loss of sight. Acute glaucoma is a medical alert. Every minute counts, as the blindness of the affected eye can become total if a treatment does not intervene quickly.
Acute Glaucoma surgery Symptoms:
The symptoms immediately preceding the crisis are decreased visual acuity, colored halos around the electric lights, pain in the eye, headache, dilated pupil. The acute crisis is characterized by rapid loss of vision, intense pulsatile pain in the eye, and photophobia (intolerance to light). Headaches and vomiting are sometimes so severe that the disease can be confused with disturbances Gastrointestinal tract. The eye becomes hard as a stone, red, misty, the cornea is cloudy as if covered with mist. With each crisis, visual loss diminishes and the field of vision shrinks.
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Acute Glaucoma surgery Treatment:
The doctor should immediately try to lower the pressure by medical treatment to help remove the aqueous humor from the inside of the eye, which reduces eye strain. No installation should be made without a prescription from the ophthalmologist, since certain medications may aggravate the condition of the patient in case of contraindication. Surgery is often necessary.
Acute glaucoma Prevention:
Regular examinations may reveal a tendency to this type of glaucoma. Rapid screening and immediate treatment will limit its development.
Prognosis: If surgery is performed early enough, the prognosis is favorable.
Laser iridotomy is the preventive and curative treatment of acute glaucoma by closing the angle. It is indicated in patients with a "narrow-angle".
Information about the procedure and risks.
Warning: There are roughly 2 broad categories of glaucoma. Acute glaucoma (most often at narrow or closed angles), and chronic glaucoma (most often at an open angle). These two types of glaucoma are completely different and it is important not to confuse them. We are talking here about closed-angle glaucoma. This information, therefore, does not apply to chronic open-angle glaucoma.
Mechanism of the acute glum by closure of the angle
The aqueous humor is produced by the ciliary body and flows from the posterior chamber through the pupil to the anterior chamber and then through the trabecular and the Schlemm canal to the bloodstream. The pupil is therefore situated between the posterior chamber and the anterior chamber. If the transpupillary flow is disturbed, then a pressure difference occurs between the two chambers.
In the case of acute angle-closure glaucoma, the pressure rises in the posterior chamber and pushes the iris in its periphery forward, so that the trabecula is blocked, the Aqueous mood outside the eye is interrupted. The intraocular pressure begins to increase very rapidly and very markedly. The "crisis" of acute glaucoma is very painful. If the eye pressure is not normalized rapidly, it can result in permanent damage to the optic nerve and vision, leading to total loss of vision in the most severe cases. Ocular hypertension requires a reduction in the pressure difference between the posterior chamber and the anterior chamber so that the iris can return to its normal position in order to clear the trabecular and allow the evacuation of the aqueous mood Resume its course.
Risk factors
Patients at risk for acute glaucoma have an angle that is judged to be narrow and closed. These are often patients with high farsightedness. It is also a hereditary condition.
Factors triggering an acute glaucoma crisis
Conditions that can trigger acute glaucoma are usually related to pupillary dilation in a subject at risk due to a narrow-angle:
Some adrenergic and anticholinergic drugs with dilating effect on the pupil (eg some cold and sinus medications, drops for pupillary dilation in the optometrist and ophthalmologist, etc.)
Intense emotions or stress with pupil dilation,
Transition to darkness or conditions of penumbra (ex-cinema), etc.
A crisis of acute glaucoma may also occur without an identifiable trigger.
Symptoms of acute Glaucoma surgery:
The fall of visual acuity, very confused vision, the perception of halos around the lights.
The pain is characteristic, often intense, with an impression that the eye is tight or that it will burst or "get out of the head", a strong sensation of pressure.
The examination shows an important redness of the eye, a pupil without a photometer reflex (no contraction to light) and rather dilated (semi-mydriasis). The eye is very very hard compared to the other palpation.
There may be extraocular signs by vagal reflex: nausea, vomiting.
In the past, iridectomy (i.e. surgical excision of a piece of the iris) was performed for this purpose. To do this, one had to open the eye, either through the cornea or through the conjunctiva and sclera. Today, thanks to the neodymium-YAG laser, a very small microscopic hole can be made in the iris without having to cut the eye. This opening makes it possible to restore a normal pressure between the two chambers and to normalize the intraocular pressure. Likewise, this opening prevents the acute glaucoma crisis by closing the angle in the subjects at risk by allowing the pressure to remain always balanced between the two chambers, leaving the trabecular clear and functional at all times. In fact, the rate of effectiveness of laser iridotomy to prevent acute glaucoma in patients deemed at risk due to their "narrow" angle is greater than 99%.
Laser Iridotomy
The procedure
Concretely, the treatment proceeds in the following manner. The pupil must first be contracted with drops that take about 30 minutes to produce their effect. Contraction of the pupil often causes a headache, so it is possible to take Tylenol as needed following the procedure. The effect of the contracting drops lasts about 3-4 hours, then the pupil resumes normal size.
The patient then receives a drop of local anesthetic, then a contact lens is placed on the eye; The laser beam can then be directed to the iris. As soon as the focus is optimal, the iris is "pulled" by several very short laser pulses in order to pierce a small opening. During this very short treatment (less than 5 minutes), the patient hears a brief detonation, and can sometimes feel a slight pinch similar to a small electric shock, but does not feel any pain as such. At the end of the treatment, its visual acuity may be temporarily reduced, on the one hand, because of the contact lens being placed on the eye and, on the other hand, because of the dispersion of the irien pigment. This slight disturbance disappears after a few hours.
In acute Glaucoma surgery, the cornea can become cloudy and oedematous, so that observation of the inside of the eye is disrupted. In these cases, the pressure (with antiglaucomatous drugs) is lowered in a conservative way and it is expected before the laser iridotomy that the cornea has cleared, thus making it possible to better see the structures of the l 'iris. In the rare cases where edema persists, surgical iridectomy is required.
Following the laser treatment, it is necessary to administer corticoid anti-inflammatory drops at a rate of 4 times per day for 5 days.
Possible risks associated with laser iridotomy
Laser iridotomy is a very safe procedure. The associated risks are rare and occur in less than 1% of cases.
Discomfort during treatment or immediately afterward as for any examination with the contact lens.
Moderate eye inflammation.
A transient rise in intraocular pressure is common but is limited by the preventive application of hypotensive drops before the procedure.
Usually, a mild hemorrhage is possible because of the blood vessels that irrigate the iris that can be affected by the laser. The ophthalmologist always ensures that there is no active salt before leaving the patient. The problem of hemorrhage may be more problematic in patients with anticoagulants (coumadin). It may then be necessary, in the case of persistent bleeding, to coagulate the blood vessels with another type of laser (argon laser).
Closure of iridotomy by scarring is rare: it requires reoperation.
Post-iridotomy dyes photopsia
Dysphotopsia is a luminous phenomenon that can occur as a result of laser iridotomy. This is a side effect that can occur in 5 to 10% of patients following the procedure. Patients then describe that they see a small "line" or "bar" of light in their peripheral vision, usually upward. This phenomenon is due to the light which can now penetrate through the small opening created by the laser in the iris. This small microscopic aperture acts as a second pupil, allowing a ray of light to pass through the eye. This phenomenon is quite benign and always transitory, that is, the symptoms always end in disappearing after a few weeks or months. The idea is not to pay attention to it so that the brain adapts and succeed in eliminating this perception more quickly.
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Glaucoma surgery: laser procedures
The LASER (Light Amplification by Stimulation Emission of Radiations) is a highly concentrated coherent light radiation used in many fields. The medical laser is a great application and one of the first areas of action has been the treatment of eye diseases. With regard to glaucoma, it has been used for over 30 years with a constant improvement of both devices and indications.
It is usually done in a room dedicated to the laser. It is done in outpatient care, without hospitalization, without the need for consultation of anesthesia, without obligation to undress, nor to be fasting.
The presence of an accompanying person is not necessarily necessary. It is recommended not to drive just after a laser treatment.
Glaucoma surgery treatment may be offered in various cases.
Open-angle chronic glaucoma
This is basically trabeculoplasty. The treatment is usually simple, fast and painless. It involves applying laser impacts to the area that is deficient in glaucoma, ie the trabecular, located in the angle between the iris and the cornea.
It is done in a sitting position, without special clothing. The eye is anesthetized with eye drops and then a suitable contact lens is applied to keep the eye open and through which laser radiation will pass to focus each impact. Various types of laser can be used: Argon, Yag doubled frequency, Diode, Selecta.
Preparation may be necessary with eye drops or tablets.
Anti-inflammatory eye drops are often prescribed.
It is proposed when the medical treatment followed is ineffective or poorly tolerated. It can also be proposed from the outset in certain indications.
Glaucoma surgery by closing the angle
Peripheral iridotomy (or iridectomy) is performed. To allow a better passage of the aqueous humor from its place of production (the ciliary body) to its place of resorption (the trabecular) a micro-hole is created at the periphery of the iris masked by the upper eyelid. The piercing of the iris is more or less long according to its thickness, its color, and its visibility through the cornea.
The radiation used is the Yag laser often completed by the thermal laser. As with trabeculoplasty, the eye is anesthetized by eye drops, it is realized in a sitting position and a glass is placed to keep the eye open and to focus the laser beam.
Iridotomy is proposed in two circumstances.
Preventively when the anatomy of the eye is such that it predisposes to the appearance of the disease (narrow iridocorneal angle).
When the disease is declared with a partially closed angle and an intraocular pressure that exceeds normal.
When there is a permanent and complete accumulation between the iris and the cornea (one speaks then of "synechiae") one can no longer resort to laser treatment and surgery is necessary then.
In some rare forms of closed-angle glaucoma (iris tray) laser treatment can be proposed to remodel the periphery of theirs (rhinoplasty).
As a result of surgery
One can cite essentially the son io puncture which makes it possible to improve the result of a splenectomy.
The laser can be used to cut the wires after trabeculectomy.
In case of refractory Glaucoma surgery
In the case of refractory glaucoma (that is to say governing badly to the usual surgery), one has the possibility of using the laser on the ciliary body. By weakening a number of ciliary processes, the production of aqueous humor is reduced and the intraocular pressure is thus reduced.
This is a special laser (laser diode) applied directly to the eye using a disposable probe. The session is done in the extended position, in the operating room because it requires a deep anesthesia of the eye. A consultation of anesthesia is, therefore, necessary.
Further information
Laser may be used
In the case of so-called neovascular glaucoma to treat the retina by a thermal laser;
- after a combined cataract and glaucoma procedure when the capsule behind the crystalline implant opacifies (Yag laser capsulotomy).
General questions about lasers
Is the laser painful?
In general not because the eye is anesthetized. The majority of patients experience no pain during treatment but feel that something is being done. Some people have the sensation of a small localized string.
Does the laser involve risks?
Zero risk does not exist and any intervention involves risks that are serious but very rare.
Any treatment proposal evaluates the risk of doing nothing and leaving the situation as it is by comparing it to the different treatments and their risks.
We then choose the least risky solution.
The risks of loss of vision after laser iridotomy or trabeculoplasty are exceptional and the most serious incidents that have occurred are not usually due to the laser treatment but to other events that have occurred concomitantly.
In practice how will Glaucoma surgery treatment happen?
You are not admitted to the hospital, but you have to plan to be accompanied. If your second eye is good you can take public transport but it is not possible to drive after a laser session.
Your face is placed on the chin of the microscope, forehead pressed forward as when examining the eyes.
Anesthetic eye drops are instilled and a lens is then placed on your eye to keep the eye open and focus the laser beam.
Avoid abrupt movements by thinking of "something else" to avoid being too contracted.
A laser session lasts only a few minutes.
Is the laser presenting a danger during the session?
Exceptionally. Ophthalmologists are accustomed to avoiding accidental burns by lifting the foot of the laser pedal if the eye moves.
Concentrate on following the instructions given to you during the few minutes of the laser session.
Can we have Glaucoma surgery several times?
Yes because different forms of glaucoma can associate (closed angle then open angle).
Will I continue to instill drops after my laser procedure?
This depends on the type of laser that will have been made in your home.
In most cases, preventive treatment of closed-angle glaucoma will not be necessary (except for a systematic anti-inflammatory treatment a few days after the laser). However, lifelong surveillance will be required to detect open-angle glaucoma.
If you have open-angle glaucoma, the complete efficiency of the laser on intraocular pressure is judged after a few weeks and it is very often necessary to install additional drops.
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