Glaucoma Laser Surgery

Surgery for glaucoma aims at lowering eye pressure, thereby preventing further optic nerve damage and subsequent vision loss.

What is laser surgery for glaucoma?

Laser surgery can be useful to improve fluid outflow or reduce fluid production, especially when drops are irritating and or do not reduce pressure enough.

The types of laser therapy include:

• Trabeculoplasty: Trabeculoplasty is used for open-angle glaucoma to increase fluid outflow. Open-angle glaucoma is the most common type of glaucoma. It can be used instead of or in addition to eye drops. Your Union Square Eye Care eye surgeon uses a special laser to improve the drainage angle to reduce eye pressure.
• Iridotomy is for people who have angle-closure glaucoma. Your Union Square Eye Care eye surgeon uses a laser to create a tiny hole in to create in the iris, allowing fluid to flow more freely. It is an outpatient procedure that takes ten minutes.
• Cyclophotocoagulation (CPC) is a procedure that uses a laser and targets the middle layer of the eye to reduce fluid production.

What is surgery for glaucoma?

When medications and laser surgery are not effective in controlling eye pressure, and in more advanced cases, surgical interventions may be considered:

• Trabeculectomy is a surgical procedure that involves creating a new drainage path for eye fluid to drain and lower intraocular pressure. It will be recommended when your glaucoma is inadequately controlled by medical therapy and interocular pressure puts you at risk for progressive glaucoma damage. It has been used for decades with much success at significantly lowering fluid in the eye to reduce the likelihood of pressure damage on the optic nerve. This is an outpatient procedure.
• Glaucoma implant surgery involves placing a small drainage tube in the eye to provide a new channel for fluid to drain from the eye. A glaucoma drainage tube may be recommended when eye drops, and laser treatments have not lowered eye pressure enough. This is an outpatient surgery minimally invasive procedure that takes an hour or less. It is safe and effective and allows for quicker recovery times and fewer complications.
• Minimally invasive glaucoma surgeries (MIGS) have become more common due to their safety profile and quicker recovery times. These procedures use microscopic equipment, microscopic implants and tiny incisions to reduce eye pressure and lessen the risk of complications. MIGS have revolutionized glaucoma management with minimal tissue trauma, good post-operative recovery and improved patient satisfaction. MIGS may be used to increase outflow of eye fluid using a stent.

Laser trabeculoplasty

Laser trabeculoplasty is a procedure designed to unclog the blockage and drain the built-up fluid in the eye to reduce intraocular pressure. Laser treatment is an option for patients who cannot tolerate the medications, or when medication alone is not adequate. However, it may be recommended as a first line treatment in some cases, because it can sufficiently lower IOP without medication. The results are usually not permanent, but the use of medication may be delayed thus avoiding the unpleasant side effects. Each patient is different.

The most common types of laser trabeculoplasty are selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT). They use different lasers, but the procedure is the same. Both can be used as primary treatment for IOP reduction or as an adjunct to medication. SLT is becoming more popular as a first line treatment. The effects of both procedures diminish over time.

Laser trabeculoplasty (ALT and SLT) is a short, outpatient procedures with quick recovery and a good safety profile. Both are performed using a topical anesthetic. During the procedure laser energy is applied to the drainage tissues in the eye to improve the function of the eye’s drainage system. Treatment reduces the development of scar tissue and causes only minimal discomfort after treatment. After surgery you may still need medications to control eye pressure, as the results of treatment may take 4-6 weeks to work.

Usually half the eye is treated at one time, and the procedure can be repeated on the other half if necessary. Patients may see a flash of green or red during the procedure. Side effects may be soreness and swelling. The vast majority of patients return to their regular daily activities within 24 hours after their laser procedure. You may need to continue your medication even after surgery. The effects wear off with time, lasting 1-5 years for most patients, but you can undergo another laser procedure or your USEC surgeon may recommend another treatment.

Microinvasive Glaucoma Surgery (MIGS)

When eye drops and laser trabeculoplasty fail to control IOP, MIGS is a group of operations designed to treat high IOP. It may be a miniaturized version of traditional trabeculotomy, a bypass operation, or the insertion of a shunt, an implantable glaucoma drainage device.

The goal is to lower IOP pressure to reduce the risk of damage to the optic nerve. MIGS use microscopic equipment and tiny incisions which reduces the risk of complications. These procedures are reserved for patients with mild to moderate glaucoma with uncontrolled IOP despite eye drops and laser therapy. MIGS have a high safety profile, a quick recovery and longer-term control of glaucoma.

Union Square Eye Care specializes in glaucoma laser surgery, providing advanced treatment options tailored by our ophthalmologists. Located in Union Square and Harlem, we serve patients from Greenwich Village, Soho, and Midtown Manhattan, offering minimally invasive procedures to manage glaucoma effectively.

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References

• Balas M, Mathew DJ. Minimally Invasive Glaucoma Surgery: A Review of the Literature. Vision (Basel). 2023 Aug 21;7(3):54. doi: 10.3390/vision7030054. PMID: 37606500; PMCID: PMC10443347.
• https://www.aao.org/eye-health/diseases/what-is-glaucoma
• https://www.americanglaucomasociety.net/patients/patient-education
• Gurnani B, Tripathy K. Minimally Invasive Glaucoma Surgery. [Updated 2023 Aug 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK582156/
• https://eyewiki.aao.org/Trabeculectomy
• https://www.aao.org/eye-health/diseases/glaucoma-drainage-implants