Glaucoma – Surgical Therapy
There are many different surgical options available for glaucoma. The best option for you will depend on many factors, including the type of glaucoma, severity and other medical problems. With all glaucoma procedures, you should not drive until you have been given the all clear for driving from Dr Oakley.
Your vision may take a few days or weeks to return to baseline after glaucoma surgery, and in some instances, you may need to update your glasses when the healing has finished in order to optimise your vision.
Despite having surgery for your glaucoma, you will still need to have ongoing monitoring, and may need to have additional treatments in the future to control your glaucoma and prevent vision loss.
This includes:
- Minimally invasive glaucoma surgery
- Minimally invasive bleb surgery
- Trabeculectomy
- Glaucoma Tube Surgery
Minimally Invasive Glaucoma Surgery
There are a number of surgical procedures which fall under the umbrella term ‘minimally invasive glaucoma surgery’ or MIGS. These procedures are typically stents inserted at the time of cataract surgery, to address both cataract and glaucoma. There are a number of different devices available, and Dr Oakley will discuss the best option for you during your consultation.
MIGS is done in conjunction with cataract surgery. A small stent is placed in the drainage angle prior to the cataract being removed. It takes an additional 10 minutes on top of a standard cataract procedure, and there is no increased risk of complications. This procedure is usually performed with local anaesthetic and sedation. Visual recovery is very quick, with improvement in vision in the first 24-72 hours.
The follow-up is the same as for a routine cataract patient in the postoperative period. You will be reviewed the following day, week 1 and then 4-6 weeks after the procedure. You will require lifelong follow up and monitoring for your glaucoma. If you were on drops for glaucoma prior to the procedure, you may be able to stop your glaucoma medications afterward, but this will be reviewed at your week 1 appointment. You will need routine postoperative drops including anti-inflammatories and antibiotics for your cataract procedure.
Minimally Invasive Bleb Surgery
The preserflo is a modern device, offering minimally invasive glaucoma surgery for patients with moderate to severe glaucoma which is getting worse. Similar to a traditional trabeculectomy in many ways, however, due to some design features of the preserflo, the device allows the procedure to be carried out with a smaller incision, allowing for faster recovery.
The procedure takes approximately 20 minutes in total. A small implant is inserted into the eye during the procedure, to allow fluid to drain from the eye and lower the IOP. The procedure can be completed under local anaesthetic with sedation and you can go home the same day. At the end of the procedure there is a small stitch, which is removed at the two week follow up.
Follow up will be at day one then weekly for the first 2 weeks, before stretching fortnightly. You will need to use antibiotic drops for at least 1 week and anti-inflammatory drops for 12 weeks after the procedure. It is likely you will be able to stop your glaucoma medications after having this procedure, however, this will be reviewed during the postoperative period.
Trabeculectomy
This is a traditional glaucoma procedure, where an incision is made in the white of the eye (sclera) to create a trap door, forming a new drainage pathway for fluid to exit the eye. This is typically performed when your glaucoma is not responding to other treatment options.
The procedure takes approximately 30 minutes to complete. Usually it is performed under local anaesthetic with sedation and you can go home the same day. There are stitches in the eye at the end of the procedure. These are typically removed at 1-2 weeks, depending on healing.
You will be seen in clinic the following day, and then weekly for 2 weeks. Your follow up after this will depend on your individual circumstance. You will need to use antibiotic drops for at least 1 week after the operation, and anti-inflammatory drops for 12 weeks. It is likely you will be able to stop your glaucoma medications, however, this will be reviewed by Dr Oakley.