Glaucoma Treatment

Treatments

Laser peripheral iridotomy was a treatment used for the narrow angle glaucoma. The doctors use an Nd:YAG laser to make a small hole in peripheral iris. This will improve the circulation of the fluid inside the eye & widens the anterior chamber angle. Fluid that was produced behind the iris has very easy access to the eyes internal drainage system. Rarely this lowers intraocular pressure, but that was not the primary goal of the laser peripheral iridotomy. The primary motto of the procedure was to lessen the risk of the acute angle-closure glaucoma.

PROCEDURE:
Patient needs to arrive one hour before the scheduled time of the surgery. After checking in, patient was being admitted to the preoperative area.

Then the nurse will administer some eye drops that will constrict your pupils.

After 15 - 30 minutes, patient will be shifted to the laser room, where the exact and main procedure will be started. Your doctor will use the Nd:YAG laser to create a small hole in peripheral iris of the involved eye(s).

By performing this procedure, you may see a brief flash of the light, hear a clicking sound, & possibly feel a slight stinging sensation. This procedure will last only for few minutes.

Your eye pressures will be checked soon after the treatment was done. Then patient will be discharged home and resume their normal activities.

Doctor may prescribe some of the anti inflammatory eye drops which needs to be used for some days after the surgery.

Patients rarely experience transient mild redness, discomfort, light sensitivity, & blurred vision.

What is Diode CYC?
Diode CYC is a laser procedure that is used to treat glaucoma. It is generally recommended after other more conservative surgeries like trabeculectomy filter or tube surgeries have failed. It is also used if the vision is already very poor.

What is Diode CYC?
Diode CYC was a procedure in which the laser was used to destroy a part of the ciliary body, the circumferential structure which lies behind & adjacent to the peripheral iris (colored part of the eye.). As the ciliary body constantly produces aqueous humor, which is the clear liquid which fills the front of the eye, destruction of part of the ciliary body decreases fluid production in the eye & thus decrease intraocular pressure.

How is Diode CYC done?
After the eye is numbed with a local anesthetic, the laser probe will be positioned over the ciliary body. The laser beam will travels from the sclera (the white part of the eye) to the ciliary body, which is moderately destroyed. The sclera is relatively unharmed as the laser energy is selectively destroys the darker pigmented ciliary body tissue beneath. Laser spots are applied over 270 degrees of the ciliary body. The main goal of the treatment is to leave enough ciliary body alive to produce aqueous liquid but to destroy enough of it to successfully lower the eye pressure. Multiple treatments may be needed.

Content will be updated soon !

Content will be updated soon !

Content will be updated soon !

Content will be updated soon !

Glaucoma drainage implants are the small prosthetic devices which are placed to help in lowering the intraocular pressure & prevent the further optic nerve damage. Glaucoma drainage implant operation is an alternative to the Glaucoma Filtration Surgery called as trabeculectomy. In some patients, especially those with certain types of glaucoma like aphakic glaucoma, neovascular glaucoma, & uveitic glaucoma, trabeculectomies are known to have a less success rate in reducing intraocular pressure because of an aggressive healing response. Also, in patients who have already undergone other eye surgeries, a glaucoma drainage device usually works better than a trabeculectomy procedure to control the intraocular pressure.

PROCEDURE:

Implantation of the glaucoma drainage device requires a careful attention to detail at each and every step of the procedure to improve the results & minimize the postoperative risks or complications.

Initially, a fornix-based or limbus-based conjunctival cut or incision is performed to allow the adequate exposure of insertion of the plate. A corneal or scleral suture will be placed to improve the exposure in working quadrant.

The implant is anchored in between 2 rectus muscles along with the anterior edge nearly 8 - 10 mm size posterior to the limbus. Larger implants (Baerveldt) are inserted with a long axis which is directed toward the apex of the orbit & then rotated horizontally such that the tube points are directed towards the anterior chamber & the wings of the implant is under the rectus muscles.

If a 2 plate implant is used, 1 plate is positioned in each of the 2 quadrants. The tube will connect the 2 plates & is passed under or over the intervening rectus muscle.

With all the valved implants, prior to plate anchorage, the tube needs to be primed with the balanced salt solution with a 30-gauge cannula to make sure that the valve leaflets are not fused after the sterilization techniques.

The tube of nonvalved implant needs to be irrigated as well to make sure of its patency. Once the implant is correctly positioned, the plate is secured to the globe with 2 non-absorbable sutures that is 8-0 or 9-0 nylon sutures on a spatulated needle.

The suture knots are rotated into the fixation eyelets to prevent erosion by the conjunctiva. Secure attachment to the underlying sclera is required to prevent the anterior, posterior, or lateral migration of the implant in the postoperative period

After the plate has been attached to the globe, the tube is laid across the cornea & cut with the sharp scissors to develop a beveled edge with the opening which is toward the cornea.

The tube should extend nearly 2.5 - 3 mm into the anterior chamber to reduce the risk of the tube-cornea touch or retraction out from the anterior chamber.

A 23-gauge needle is used to create a track by which the tube is inserted into anterior chamber just anterior & parallel to the iris. The tube can be protected to the sclera a few millimeters anterior to the plate with 7- 0 or 8-0 Vicryl suture. This suture helps to stabilize the tube & they shouldn’t be tight; if not, it will restrict the flow in valved devices.

The tube is covered to stop its erosion by the conjunctiva. Patch graft materials include processed pericardium, dura, sclera, fascia lata or cornea. The patch graft needs to be secured to the globe with the interrupted sutures at anterior corners by using 8-0 Vicryl or nylon sutures.

If the patch graft material is not available, a partial thickness scleral flap will be constructed. The needle track & tube entry are done under this flap.

This flap is then sutured with 10-0 nylon sutures. After the patch graft has been placed, the conjunctiva & Tenon layers are dragged over the plate, tube, & patch graft & secured into the place with help of 8-0 Vicryl suture.

In certain cases, the monofilament 9-0 Vicryl suture is preferred due to its higher tensile strength & finer vascular needle to prevent the buttonholes when handling thin conjunctiva.

At the end of the surgery, the eye will be inspected to make sure that the implant plate, patch graft, & intraocular portion of the tube are in a good position.

Fluorescein drops or strips will be used to inspect the conjunctiva for the leaks. Any buttonholes if found in the conjunctiva needs to be closed with 9-0 Vicryl suture. At the end of the procedure, a subconjunctival injection of the antibiotic & steroid is given.

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