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Glaucoma Surgery

A Closer Look at Laser & Incisional Glaucoma Surgery Types

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As you already know, glaucoma is a progressive, chronic deterioration of the optic nerve that is commonly caused by increased IOP. However, there are multiple types of glaucoma surgery and devices designed to lower IOP, which will help slow down or prevent nerve damage. Although most cases of glaucoma can be managed with medications, different glaucoma surgery types may be required in certain cases. Continue reading for a list of the most common laser and incisional glaucoma surgery types. 

Laser vs Incisional Types of Glaucoma Surgery

In general, there are two primary types of surgical procedures: laser and incisional. 

Laser Types of Glaucoma Surgery

In most instances, ophthalmologists will suggest laser surgery prior to incisional procedures, unless the optic nerve is badly damaged or if the patient's IOP is very high. During the laser procedure, a highly focused beam of light is used to treat the trabecular meshwork of the eye to help increase the flow of fluid. 

Incisional Types of Glaucoma Surgery

When laser surgery doesn't achieve the desired result or if the IOP starts to rise again, you may suggest incisional surgery. Incisional surgeries involve the use of surgical tools to create a hole for drainage. 

Once created, the new opening allows the fluid to bypass the clogged canals and properly flow out of the artificial openings. In some instances, incisional surgical procedures may need to be repeated after long periods of time or when excessive scarring can't be avoided. 

Laser Trabeculoplasty Type of Glaucoma Surgery

Ophthalmologists can perform laser trabeculoplasty to help increase the outflow of internal eye fluid. During this procedure, a laser is used to create small holes in the filtration angle of the eye — where the iris and cornea meet. With the newer version of this procedure — selective laser trabeculoplasty — the surrounding tissue suffers minimal damage from heat, which means the selective laser trabeculoplasty can be safely repeated. 

Laser trabeculoplasty is typically performed as a supplement to eye drop therapy. However, much research is being conducted to determine whether the selective laser trabeculoplasty could be used regularly as a first-line therapy for open-angle glaucoma as well as other forms of glaucoma — prior to drops being used. 

Glaucoma Surgery Types that Create New Channels

There are multiple types of glaucoma surgery designed to create new channels to promote a more normal flow of fluid. One procedure, the trabeculectomy, involves partially removing the drainage system in the eye. In doing so, a controlled leak of the aqueous humor is created. 

It filters underneath the conjunctiva, and a tiny conjunctival bubble will appear where the surgically-created valve is made. Other types of procedures that involve the creation of new channels for the flow of fluid include:

  1. The goniotomy is primarily used for small children and infants. With this procedure, a special lense is required to view the inner eye structures to effectively create openings in the trabecular meshwork, which will allow fluid drainage. 

  2. The trabeculotomy procedure is very similar to the trabeculectomy — except incisions are made without removing any tissue. 

Iris-Related Types of Glaucoma Surgery

There are two different types of iris-related surgeries that can be used to treat glaucoma. 

  1. The iridotomy uses a laser to create a hole in the iris to help clear the drainage passages that are blocked by a part of the iris. 

  2. The iridectomy involves the surgical removal of a tiny piece of the iris to promote better fluid flow in patients with narrow-angle glaucoma. 

Glaucoma Implants and Shunts

Stents and shunts are tiny devices that are surgically implanted into the eye to reduce high eye pressure and promote the free flow of fluid. These shunts and stents work to forge an alternate pathway for the liquid to drain from the eye, bypassing the clogged or damaged filtration drainage canals. Today, there are a range of different implants and shunt devices that are FDA approved for glaucoma surgery. 

iStent Trabecular Micro-Bypass

iStent Trabecular Micro-Bypass is a system engineered by Glaukos Corp and is available in Canada, US, and Europe. The device is primarily for open-angle glaucoma and may be used with cataract surgery to reduce IOP of patients. The device is manufactured from surgical-grade titanium and is placed in Schlemm's canal to promote a more normal flow of liquid.

Ex-Press Glaucoma Filtration Device

Manufactured by Alcon, the Ex-Press is a tiny stainless steel shunt that has been approved by the FDA and in use since 2002. It's approximately the size of a grain of rice and is implanted underneath a tiny flap in the sclera. Once in place, the Ex-Press allows aqueous fluid to successfully exit the eye to help patients have a lower IOP.

Xen Gel Stent

The Xen Gel Stent has been approved by the FDA since November 2016. The Xen Gel Stent is a collagen-based, gelatin implant that works to lower IOP by creating a drainage pathway. While the Xen Gel Stent can be placed as a stand-alone procedure, it's commonly placed in conjunction with cataract surgery. 

Hydrus Microstent

As the name suggests, the Hydrus Microstent is a very tiny implant. Manufactured by Ivantis, the Hydrus Microstent is primarily being tested for treating open-angle glaucoma. The Hydrus procedure is significantly less invasive than the standard glaucoma surgery and can even be performed during cataract surgery utilizing the same incisions. 

Contact Keeler Ophthalmic Instruments 

At Keeler, we're proud to be a leading provider of ophthalmic equipment and instruments. Contact us today to learn more about our cutting-edge ophthalmic instruments.

About the Author Eugene VanArsdale

Eugene is the Director of Marketing Communications at Keeler Instruments. He has been with Keeler since 1982 and is co-holder of two patents for the company. Eugene has a true passion for the eye care industry and has dedicated himself to understanding the ins and outs of the optometric and ophthalmic equipment market.