Minimally Invasive Glaucoma Surgery

 

Through extensive clinical research and trials, doctors and researchers are constantly creating new and exciting treatment methods for glaucoma patients. These innovative procedures combine the newest technology, enhanced surgical methods and breakthrough drugs to normalize intraocular pressure and manage your glaucoma. Talk to your doctor to see if one of these innovative procedures will help preserve your vision.

 

Trabectome

If you have open-angle glaucoma that is not adequately controlled, you may be a good candidate for trabectome surgery. The trabectome is a probe-like device that is inserted into the anterior chamber of the eye to open the eye’s drainage system. The probe delivers thermal energy to the trabecular meshwork of the eye, removing the covering of the drain that limits fluid flow and allowing the aqueous humor to flow more freely, lowering intraocular pressure (IOP). The surgery can be performed as a single surgery without cataract removal, but most often it is combined with cataract surgery.

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What Happens During Trabectome?

Your doctor will use numbing drops or a combination of injected anesthetic and IV sedation for comfort. The surgery is minimally invasive and requires a tiny incision to position a small probe. The probe delivers thermal energy to the trabecular meshwork of the eye. This allows the aqueous humor to flow more freely and lowers the IOP. The entire procedure takes between 5 to 10 minutes.

What to Expect

Your doctor will go over your current medications and advise you accordingly. You will go home the same day of the surgery, but you must have a caregiver drive you home. You may be given antibiotics and anti-inflammatory medications, and you should avoid strenuous activities for at least one week.

Outcomes

Studies show that trabectome usually lowers eye pressure by about 20-30 percent and reduces the number of glaucoma eye drops that are required. Trabectome surgery does not affect any future traditional glaucoma surgeries that may become necessary.

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Kahook Dual Blade

The Kahook Dual Blade (KDB) is a new minimally invasive option for treating glaucoma. It can be a good option for anyone with open-angle glaucoma, including patients whose intraocular pressure (IOP) is not affected by medication or those who have medication allergies or intolerances. This procedure is very similar to the trabectome, only it uses a disposable blade instead of an electrocautery. The procedure can also be combined with cataract surgery, without noticeably affecting recovery.

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What Happens During a KDB Surgery?

The KDB performs a goniotomy, a procedure that does not damage the scleral wall or leave shunts or other foreign bodies in the eye. Parallel incisions are made through the trabecular meshwork to remove a section of the tissue and allow increased aqueous flow, thereby lowering IOP.

What to Expect

Goniotomy is an outpatient procedure. You will go home the same day, but you must have a caregiver drive you home. You will be given antibiotics and topical steroids to take for a few weeks.

Outcomes

KDB has thus far been proven to be a safe and effective method for lowering IOP and reducing the need for glaucoma medication, especially for those with a cataract.

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Micro-Invasive Glaucoma Surgery with Cataract Surgery

New developments in Micro-Invasive Glaucoma Surgery (MIGS) allow patients to have glaucoma and cataract surgery during one procedure, and most patients with a cataract and open-angle glaucoma are good candidates. Most MIGS procedures avoid eye tissues that are often utilized by traditional surgeries, allowing for future treatment options.

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What Happens During MIGS?

The cataract removal and microstent procedure are usually performed under local anesthesia and only take about 15 to 20 minutes per eye. Your surgeon will first perform the phacoemulsification operation to remove the cataract. Using an ultrasonic device, the cloudy lens is broken up and removed, and an artificial intraocular lens (IOL) is inserted. Using the same incision, the titanium microstent will be inserted by a preloaded, single-use, sterile applicator. Your doctor will slowly advance the stent into the trabecular meshwork of your eye and push the button on the inserter to release the device.
This specially designed stent can reduce intraocular pressure (IOP) in adult patients who are currently taking IOP medication for mild or moderate open-angle glaucoma and who have a cataract. The insertion of the stent only adds a few minutes to the cataract surgery. Adding no significant risk to the procedure, the microstent can help greatly in the control of IOP and can reduce the number of medications that you are taking.

What to Expect

Bring a list of your current medications and a brief medical history to your pre-operative appointment, as your surgeon may recommend that you stop taking certain medications about a week before the surgery. MIGS is an outpatient surgery, so you can go home the same day. However, you will need a caregiver to drive you home. Depending on the patient, and if both eyes require treatment, it is common for the second eye surgery to be scheduled for 2-3 weeks later. You will receive antibiotics and anti-inflammatory eye drops to use for the next several weeks after surgery. Recovery time is brief, but your doctor will recommend that you avoid strenuous activities for one week.

Outcomes

Micro-invasive glaucoma surgery with cataract surgery is safe and effective in treating primary open-angle glaucoma and a cataract. The microstent procedure does not noticeably increase the risk of the cataract procedure, and some patients have been able to discontinue glaucoma drops after surgery. If you have a cataract and primary open-angle glaucoma, talk to your doctor about MIGS and cataract surgery.

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Canaloplasty

Canaloplasty is a non-penetrating procedure primarily for open-angle glaucoma. It is designed to restore the eye’s natural drainage system and provide sustained reduction to intraocular pressure (IOP). Canaloplasty is less invasive than other traditional surgical procedures because it works just on the surface to enlarge the eye’s natural drainage to restore natural flow out of the eye. Canaloplasty is potentially a good fit for patients who have a higher risk of infection or bleeding or patients who are at higher risk of complications with trabeculectomy.

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What Happens During Canaloplasty?

Your surgeon will first numb your eye and make a small incision to place a microcatheter into your eye’s drainage canal. Using the microcatheter, your doctor will enlarge the drainage canals to help the aqueous humor to drain more effectively. Your doctor will then remove the microcatheter and use sutures to keep the drainage canals open.
The entire procedure takes between 30-45 minutes, depending on the patient.

What to Expect

Your surgeon may ask you to stop taking certain medications before surgery and will advise you when you may safely resume taking them again. Canaloplasty is an outpatient procedure, but you will need a caregiver to drive you home. You will be given drops to reduce inflammation and prevent pain and infection. You may feel a scratchy sensation in your upper eyelid for up to a few weeks from the sutures that eventually dissolve.

Outcomes

Canaloplasty does not cure glaucoma but it slows the progression of the disease. Visual recovery is often faster when compared to other traditional glaucoma surgery procedures, and because it is minimally invasive, there is lower risk of complications and scarring.

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ECP

Endoscopic cyclophotocoagulation (ECP) is a laser procedure commonly performed during or after cataract surgery. For patients needing treatment for cataracts and glaucoma, ECP can reduce or eliminate the need for glaucoma medications.

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What Happens During ECP Surgery?

During cataract surgery, a very small incision is made and an ultrasonic probe is inserted to break up and gently remove the cataract from the affected eye. An intraocular lens (IOL) is then inserted to provide the best corrected vision to the patient. Once the cataract is removed, the ECP probe is inserted into the same small incision. ECP uses tiny optical fibers to view and treat the ciliary body of the eye with laser energy. This reduces fluid production and lowers intraocular pressure (IOP).

What to Expect

ECP does not greatly affect recovery from standard cataract surgery. The outpatient procedure does require a caregiver to drive you home, and during recovery you should avoid any significant physical activity, lifting or straining. You may be prescribed topical anti-inflammatory and antibiotic as well as glaucoma medication.

Outcomes

ECP can be an effective part of a treatment plan for patients with mild to moderate glaucoma and cataracts with minimal risks and downtime. For some patients, ECP can eliminate the need for glaucoma medications.

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