Have you ever heard the words 'high eye pressure' or 'glaucoma'? Maybe someone in your family has this condition. It's actually a bit scary, because high eye pressure can cause permanent damage to our vision. But don't worry, today's medicine is very advanced. One of the most effective and safe treatments for this is a surgery called goniotomy. Let's see what it is, how it is done, and what are the benefits of it .
Simply put, what is a goniotomy?
Goniotomy is a special surgery performed to reduce intraocular pressure . It belongs to a category called Microinvasive Glaucoma Surgery (MIGS) . "Microinvasive" means surgery performed using very small, delicate instruments and without causing significant damage to the eye.
Aqueous humor is constantly produced and drained from our eyes. If this fluid is not drained properly, the pressure inside the eye increases. This is what we call glaucoma. Goniotomy surgery opens the path through which that fluid flows and reduces the pressure. This prevents damage to the optic nerve caused by glaucoma and protects our vision.
The important thing is that this surgery can only stop further damage . It cannot reverse damage that has already occurred. That is why it is important to diagnose and treat the disease early.
Who is most likely to have this surgery?
In the past, goniotomy surgery was mostly performed on young children with congenital glaucoma . However, with advances in technology, it is now being used very successfully for various glaucoma conditions in adults.
Your ophthalmologist will examine you and decide if this surgery is appropriate for your type and condition of glaucoma.
How do you prepare before surgery?
Your eye surgeon will explain everything to you before the surgery. They will usually talk about these things:
- Medications you take: You should tell your doctor about all the medications you take (including vitamins and herbal remedies). Some medications (especially blood thinners) may need to be stopped a few days before surgery.
- Anesthesia: Anesthesia is used to prevent pain during the surgery. You may only be numbed in the eye, or you may be completely anesthetized. The anesthesiologist will explain this to you.
- Fasting: You will be asked to refrain from eating or drinking for about 8 hours before the surgery. You will also need to stop drinking fluids, such as water, 2 hours before. Follow your doctor's instructions exactly.
How the surgery is performed
This surgery is not as big as you might think. It usually takes about 15 minutes to complete.
1. Anesthesia: First, you will be given medication to make you feel no pain.
2. A small incision: The eye surgeon then makes a very small incision, about a millimeter long, in the cornea of your eye.
3. Special instruments: A very fine instrument is inserted into the eye through the incision. Along with this, a special lens (Gonioscopic lens) is placed over the eye. This lens allows the doctor to see the fine structures inside the eye clearly and magnified.
4. The main task: Now the most important thing. There is a mesh-like part inside the eye that filters fluid, called the trabecular meshwork . When you have glaucoma, this mesh doesn't work properly. What the doctor does is use a delicate instrument to make a few small cuts in this mesh. This creates a new path for fluid to flow through, and the pressure in the eye decreases.
5. End: When the work is finished, the equipment is removed and a small eye shield is put on to protect the eyes.
Post-surgery and recovery period
After the surgery, you will be monitored for a while and then allowed to go home. Since you cannot drive, you will need someone to drive you home.
The doctor will prescribe several eye drops to put in your eyes. You will need to use antibiotics for a few days and anti-inflammatory medications for a few weeks.
It is normal to experience some tearing, blurred vision, and a gritty feeling in the eyes in the first few days. These will go away in a few days.
Remember these things during recovery
| Things not to do (AVOID) | Things to do (DO) |
|---|---|
| Catching the eye, crushing it. | Wash your hands thoroughly before applying the medicine. |
| Using any kind of eye makeup. | Take your medicine on time as prescribed by the doctor. |
| Bending forward, kneeling on the ground. | If you have trouble seeing light, wear sunglasses. |
| Lifting weights. | Go for follow-up check-ups on scheduled dates. |
| Exercising, running, swimming. | Be careful of your eyes when bathing and washing your face. |
Are there risks and complications?
Serious complications from goniotomy are rare . As with any eye surgery, there is a small risk of infection or pain.
Other specific, but minor complications may include:
- Minor bleeding inside the eye (this usually heals on its own in a week or two).
- Temporary increase in eye pressure.
- Minor changes in vision, for example , astigmatism .
- Very rarely, conditions such as too low eye pressure (hypotony) or retinal detachment can occur.
Your doctor will explain these risks to you in more detail.
When do you need to seek emergency medical advice?
After surgery, if you experience the following symptoms, call your eye doctor immediately:
- Unbearable eye pain .
- Sudden loss of vision or very blurred vision.
- Seeing halos around lights.
- Very red eyes or discharge of pus-like fluid from the eyes.
In an emergency like this, go to the hospital's Emergency Treatment Unit (ETU) immediately.
Take-Home Message
- Goniotomy is a very safe and successful surgery performed on people with increased eye pressure due to glaucoma.
- This helps fluid drain from the eye, reduces eye pressure, and protects vision from further damage.
- The surgery is very quick, and the recovery period is usually not painful.
- It is very important to follow the doctor's instructions exactly (such as taking medication and avoiding heavy work) during your recovery.
- It is essential to follow-up at the scheduled times. If any emergency symptoms occur, seek medical advice immediately.
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