Glaucoma, also known as “green cataract,” is a common eye disease that, if left untreated, can lead to vision loss or even blindness. It is usually caused by increased intraocular pressure resulting from an imbalance between the production and drainage of aqueous humor.
This increase in pressure can damage the optic nerve and thus permanently impair vision. Glaucoma is often initially treated with eye drops to lower intraocular pressure. If this is not sufficient, surgery is necessary to improve the drainage of aqueous humor.
Modern procedures can be performed on an outpatient basis and are considered minimally invasive. The goal of any treatment is to control intraocular pressure over the long term and preserve vision.
Background Information on Glaucoma
Glaucoma is also known as “green star.” It refers to a group of eye conditions that cause an increase in intraocular pressure. This gradually leads to damage to the optic nerve. In the most severe cases, it can lead to blindness.
Glaucoma surgery can prevent the condition from worsening.
Open-angle and angle-closure glaucoma
Generally, a distinction is made between open-angle and angle-closure glaucoma:
- Open-angle glaucoma is by far the more common form. In this condition, vision in the affected eye gradually deteriorates.
- Angle-closure glaucoma is significantly less common. It is an acute form of glaucoma. It is associated with a very painful glaucoma attack and can lead to blindness within a very short time.
Prevalence and Risk Factors
Glaucoma is one of the leading causes of blindness worldwide. The risk of developing the disease generally increases with age. About four percent of all people over the age of 75 have glaucoma. It is estimated that there are approximately one million glaucoma patients in Germany. However, the number of undiagnosed cases is very high.
There is also an increased risk of glaucoma if there have been cases of glaucoma in the family. The disease appears to be partially hereditary. Other risk factors include
- fluctuations in blood pressure,
- circulatory problems,
- diabetes, and
- severe nearsightedness or farsightedness.
In general, everyone aged 40 and older should have their eyes checked regularly. Early diagnosis is achieved through
- measuring intraocular pressure and
- assessing the optic nerve
. This allows for early treatment to minimize damage.
Treatment of Glaucoma
Conservative Treatment
Treatment usually begins conservatively with eye drops. These are intended to lower intraocular pressure. A wide variety of medications with different mechanisms of action are available for this purpose. Some of them can also be combined.
Glaucoma Surgery
Glaucoma surgery is necessary if
- the medications are not effective enough or
- the patient cannot tolerate the medications.
In such cases, the patient’s optic nerve is at risk, and there is a risk of blindness.
In most cases, this type of glaucoma surgery is performed on an outpatient basis under local anesthesia. In some circumstances, general anesthesia may be considered, such as
- for very anxious or nervous patients who cannot keep their head still for an extended period of time,
- for procedures on both eyes, and
- for longer procedures.
The duration of the procedure depends largely on
- the technique or procedure used, as well as
- the patient’s individual anatomical conditions
. In general, laser surgery takes less time than the surgical alternative. Not all forms of glaucoma are equally suitable for surgery. In such cases, the doctor evaluates which procedure offers the best prognosis and the fewest risks for the patient.
Different Glaucoma Surgery Procedures
The procedure used for glaucoma surgery depends on the exact diagnosis and cause. All methods aim to reduce intraocular pressure by
- artificial drainage channels or
- reducing aqueous humor production
. Many procedures are now performed using a laser. In such cases, a local anesthetic in the form of eye drops is generally sufficient.
Before Glaucoma Surgery
Before glaucoma surgery, the doctor will ask about any medications the patient takes regularly. This allows the doctor to rule out potential risks and complications. As a result, the patient must stop taking certain medications in the days leading up to the surgery. These include, for example, blood thinners.
If the surgery is performed under general anesthesia, the patient must not eat or drink anything for six hours before the anesthesia.
Whether the procedure is performed on an outpatient or inpatient basis depends on the type of surgery and the type of anesthesia. For outpatient surgery, the patient usually remains under observation for a few hours after the procedure.
Temporary Relief with Laser Trabeculoplasty
Laser glaucoma surgery is widely used and particularly patient-friendly. Laser trabeculoplasty increases the permeability of the trabecular meshwork in the eye. The trabecular meshwork is the tissue through which aqueous humor drains.
The laser creates small, pinpoint holes in the trabecular meshwork. This results in many small, perforated scars in the sponge-like tissue, which improve the outflow of aqueous humor. However, the effects of this glaucoma surgery are only temporary.
Iridectomy and Iridotomy
During an iridectomy, the doctor cuts a small hole in the iris. This creates an opening between the anterior and posterior chambers of the eye. This flow of aqueous humor allows intraocular pressure to regulate itself.
If a high-energy infrared laser is used for this procedure, it is referred to as an iridotomy. This procedure is now the standard of care. Iridotomy and iridectomy are the treatments of choice for angle-closure glaucoma.
Trabeculectomy
Trabeculectomy is a microsurgical procedure. Here, too, the goal is to lower intraocular pressure by improving the outflow of aqueous humor.
During the procedure, the doctor cuts a strip from the sclera of the eye to serve as a valve for drainage. The aqueous humor flows through the newly created drainage opening under the conjunctiva. The body then reabsorbs the aqueous humor.
The surgeon may also use a laser in this procedure. This is referred to as a trabeculotomy. The doctor uses the laser to create six to eight small holes for drainage.
Cyclophotocoagulation
This method of glaucoma surgery works differently. The goal here is to reduce the production of aqueous humor. This, too, lowers intraocular pressure.
Using a laser beam, the doctor ablates the ciliary body, which produces the aqueous humor. Following this procedure, scar tissue forms in the ciliary body. This prevents a large portion of aqueous humor production. Scar formation takes about six to eight weeks. Therefore, the success of the surgery can only be assessed about three months after the procedure.
The surgery can also be performed using cold (cryocoagulation). However, this method is reserved only for extremely severe cases.
Risks and Prognosis
The surgical risk depends on the technique used as well as the individual condition of the eye. In general, complications such as
- infections,
- impaired wound healing,
- visual field defects, or
- postoperative bleeding
are very rare with the various types of glaucoma surgery. Procedures that involve opening the eyeball carry slightly higher risks than laser procedures.
In some cases, the procedure may not be successful. In such cases, further surgical correction may be necessary.
Complications can be largely prevented through effective follow-up care. You should attend regular follow-up examinations. This allows for
- complications can be detected and treated early, and
- the success of the glaucoma surgery can be assessed.
The damage caused by glaucoma is irreversible. Even surgery cannot reverse it. Glaucoma surgery merely slows or stops the progression of the disease. Therefore, the procedure will not improve your vision.
After Glaucoma Surgery
For the period following glaucoma surgery, the doctor usually prescribes medication in the form of eye drops or ointments. You must follow the doctor’s instructions exactly. To minimize discomfort for the patient, the doctor often prescribes pain medication.
As part of follow-up care,
- taking the prescribed medications regularly as directed, as well as
- attending follow-up appointments with the doctor
are of great importance.
If you develop
- fever,
- bleeding, or
- pain
occur at home, you should contact your treating physician immediately.
Conclusion
Glaucoma is a serious eye disease in which intraocular pressure plays a central role and can lead to long-term damage to the optic nerve. Glaucoma is often caused by an imbalance between the production and drainage of aqueous humor, which increases intraocular pressure and puts constant strain on the eye. The goal of any glaucoma treatment is to lower intraocular pressure and improve the drainage of aqueous humor to prevent further damage. What does glaucoma treatment actually involve?
Treatment usually begins with medication, such as eye drops or an appropriate drug, but in cases of advanced glaucoma, surgery or a procedure is often necessary. This involves surgically creating an artificial drainage pathway for the aqueous humor or improving the trabecular meshwork so that the aqueous humor can drain more effectively. Modern procedures such as trabeculectomy, canaloplasty, or laser trabeculoplasty make it possible to specifically lower intraocular pressure and stabilize vision. Many procedures can be performed on an outpatient basis under local anesthesia.
With glaucoma, it is crucial to detect elevated intraocular pressure early, as an untreated increase in pressure can lead to vision loss or even blindness. A glaucoma attack is an acute form of the condition in which intraocular pressure is severely elevated and requires immediate treatment. Damage to the optic nerve and retina can be irreversible, which is why regular checkups with an ophthalmologist and consistent treatment are essential.
Treatment for glaucoma includes both conservative and surgical measures, with a focus on improving the outflow of aqueous humor. In ophthalmology, in addition to eye drops, laser procedures and minimally invasive surgeries are used to optimize the drainage pathway for aqueous humor. Treatment often targets the anterior chamber to facilitate drainage and permanently lower intraocular pressure.
In summary, glaucoma is a complex eye disease in which intraocular pressure, aqueous humor, and drainage are closely interrelated. Vision can only be preserved through early diagnosis, individually tailored glaucoma treatment, and good follow-up care.
FAQ
What is glaucoma?
Glaucoma is an eye disease in which elevated intraocular pressure can damage the optic nerve. It is usually caused by impaired drainage of aqueous humor from the anterior chamber of the eye. If left untreated, this can lead to visual field defects and vision loss.
When is surgery necessary for glaucoma?
Surgery becomes necessary when eye drops or other medications do not sufficiently lower intraocular pressure. The goal of the procedure is to improve the drainage of aqueous humor and thereby reduce the pressure inside the eye.
What surgical methods are available?
The most common procedures include trabeculectomy, canaloplasty, trabeculotomy, and the use of stents. Laser procedures such as laser trabeculoplasty are also used to treat glaucoma. These methods improve the drainage of aqueous humor and lower intraocular pressure.
How is the procedure performed?
The surgery is usually performed on an outpatient basis under local anesthesia. During the procedure, an artificial drainage pathway for the aqueous humor is created, or the trabecular meshwork is improved. The procedure is generally minimally invasive and takes only a short time.
What are the risks of glaucoma surgery?
As with any surgery, complications such as bleeding or pain may occur. Wound healing problems are also possible. Regular follow-up care and checkups with an ophthalmologist are important to ensure the success of the treatment.
About the medical author
Sabine Schneider
Editor-in-Chief
Sabine Schneider – medical author: Explore expert articles and medical expertise in the Leading Medicine Guide.
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