Surgery for glaucoma? Don't be afraid, let's talk about it! (Glaucoma Surgery)

When your doctor tells you that you have glaucoma, he or she may tell you that you may need surgery. It's normal to feel a little scared and nervous when you hear those words. "What will happen to my eyes?", "Is this a major operation?", "Will it hurt?" are all questions that come to mind. But don't worry. Today, we'll talk about this very simply, in a way that you can understand. Just like you would talk to a friend.

What exactly is glaucoma surgery?

Okay, first let's understand what glaucoma is. Simply put, glaucoma is a general name for a group of conditions that damage the optic nerve , the main nerve that carries messages from our eyes to the brain. The main cause of this is increased pressure inside the eye (Itraocular Pressure).

Imagine that our eye is like a ball filled with water. A special fluid called 'Aqueous Humor' is constantly being produced and released inside the eye. This is what keeps the eye healthy. However, in glaucoma, the channels through which this fluid flows become blocked, causing the fluid to accumulate inside the eye and increasing the pressure. Due to this increasing pressure, the optic nerve we mentioned is compressed and gradually begins to be damaged.

So, there are two main goals of glaucoma surgery:

1. Facilitating the drainage of fluid: This involves cleaning the blocked drainage system (trabecular meshwork) or creating a new pathway to allow fluid to flow more easily.

2. Reducing fluid production: Reducing the amount of fluid produced inside the eye.

With either of these two methods, the surgery hopes to control the pressure inside the eye and prevent further damage to the optic nerve.

What types of glaucoma surgery are there?

Glaucoma surgeries can be divided into two main categories. One is laser surgeries , which are usually performed in the doctor's office (office procedure). The other is incisional surgeries, which are performed in an operating room. Your doctor will decide which type of surgery is best for you based on many factors, such as the type of glaucoma you have, the severity of the disease, and the condition of your eye.

Let's now look at each of these types separately.

1. Laser Surgeries - Nothing to be afraid of, simple methods

These are often the first surgeries recommended, very simple and can be completed in a few minutes.

• Laser Trabeculoplasty: This is the most common laser surgery for glaucoma. It uses laser light to remove blockages in the drainage system of the eye. There are two types.
• ALT (Argon Laser Trabeculoplasty): This is a somewhat older method.
• SLT (Selective Laser Trabeculoplasty): This is the newest and most commonly used method. In this, the laser beam is more targeted, so there is less damage to the eye. Also, this surgery can be repeated if necessary. This is a very effective treatment for many cases of 'open-angle glaucoma' .

• Laser Peripheral Iridotomy (LPI): This is done for people with closed-angle glaucoma . A laser makes a very small hole in the colored part of the eye, the iris. This allows the fluid inside the eye to flow freely instead of pooling on one side. Sometimes, this surgery is also done to prevent glaucoma in people who are at risk of developing it.

• Cyclophotocoagulation (CPC): This involves targeting the ciliary body, which produces the aqueous humor, with a laser beam to reduce the production of the fluid. This is usually done for people with more severe glaucoma who have not responded to other treatments.

2. Incisional Surgeries - Procedures performed in an operating room

If laser treatments fail to control the condition, your doctor may recommend surgery like this. These are performed in an operating room.

• Trabeculectomy: This is the main surgery that has traditionally been performed. Here, the surgeon makes a small incision in the white part of the eye (sclera), removes part of the drainage system, and creates a new path for the fluid to drain. This can be very effective in reducing pressure inside the eye.

• Tube Shunt: This is another method. Here, a very thin, small tube is inserted into the eye to drain the fluid from inside the eye. This is also a successful method used for severe glaucoma.

• Minimally Invasive Glaucoma Surgery (MIGS): This is the latest technology in this field. This surgery is performed through a very small incision using very small instruments and implants. This results in a shorter recovery time and fewer complications. Often, MIGS can be performed at the same time as cataract surgery. This is best for people who are in the early stages of the disease.

How should you prepare before surgery?

When you have a surgery date, the doctor will meet with you before the surgery. At that time, the following things may happen:

• Eye exam: Your eyes will be thoroughly examined and several necessary tests will be performed.
• Talking about your expectations: Explaining what to expect and what to do after surgery.
• Health history: Ask about other illnesses you have and the medications you take (especially blood thinners ).

In addition, they will give you a list of things to do before the surgery. This may vary from person to person, but in general, these are the things to do.

What happens during and after the surgery?

During surgery

What happens will vary depending on the type of surgery you have.

• Laser surgery: This is often done in the eye doctor's office. You will be asked to sit in a chair, numbing eye drops will be applied to your eye. Then a special lens will be placed in your eye and the laser will be used to treat it. This will only take a few minutes. You will not feel any pain.
• 'Cutting' surgeries (Trabeculectomy, Tube Shunt, MIGS): These are done in an operating room. You may be given IV sedation or general anesthesia, so you won't feel any pain. These surgeries can take anywhere from 30 minutes to an hour .

After the surgery

After the surgery, the doctor will check your eye pressure.

• After laser surgery, you can go home in a few hours.
• After surgery in the operating room, you will need someone to accompany you. You may be given an eye patch.
• Recovery time varies depending on the type of surgery. After laser surgery, you can resume normal activities within a day. However, after an 'incision' surgery, you will be asked to refrain from heavy lifting and bending for a few weeks.
• You will be given some eye drops to put into your eyes. These are to prevent infection and speed up healing. It is very important to put these eye drops in exactly as directed, at exactly the right time.
• You will be asked to come for follow-up appointments in the days and weeks after surgery. It is important to keep these appointments.

If you have these symptoms, call your doctor immediately.

When you go home after surgery, it's important to recognize any risk factors as soon as possible. If you experience any of the symptoms below, you should call your doctor immediately .

• If you experience unbearable, severe eye pain .
• If your vision suddenly decreases or becomes blurry.
• If the eyes become very red and teary.
• If you experience nausea or vomiting.

This doesn't happen often, but if it does, it could be a sign of an infection or other complication and requires prompt treatment.

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