Advanced Glaucoma Surgery
Patients at risk for vision loss or whose glaucoma is not adequately controlled with medications and laser may benefit from glaucoma surgery. These surgeries include trabeculectomy, ExPRESS shunt surgery and glaucoma drainage implants (such as Baerveldt and Ahmed implants). All of these surgeries create an alternate drainage pathway out of the eye.
Glaucoma Drainage Implants
Glaucoma drainage implants consist of a silicone tube which drains to a reservoir where the fluid is reabsorbed by the body. The tube is placed into the anterior chamber (space between the iris and cornea) and the reservoir is located underneath the conjunctiva (the clear membrane over the eye) near the equator of the eye. Drainage implants can be used as the first surgical intervention for a patient, but frequently are used in patients who have already had prior glaucoma surgeries. After surgery, the pressure in the eye will fluctuate as the body heals, which can take from a couple weeks to several months.
The traditional glaucoma surgery is a trabeculectomy. An artificial drainage pathway is created so that aqueous fluid can percolate from the anterior chamber to underneath the conjunctiva. As the fluid drains, a filtering bleb forms. Blebs often resemble a blister or elevation on the white part of the eye. During the post-op period, patients may require other procedures, such as laser treatments or application of medications, to ensure scar tissue does not close off the artificial pathway.
ExPRESS shunt implant
The ExPRESS shut is a titanium implant placed inside the anterior chamber that results in fluid draining underneath the conjunctiva where the body can reabsorb it. This procedure, like a trabeculectomy, also results in the formation of a bleb. The ExPRESS shunt works well in patients who require very low intraocular pressure to treat their glaucoma. View Video
Many options exist for treating glaucoma and more are in development. Ultimately, treatment needs to be individualized to each person. A cure for glaucoma does not currently exist and patients will still need to be monitored after treatment is initiated.