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. Trabectome is a probe-like device that is inserted into the anterior chamber of the eye to remove the covering over 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. The surgery can be performed as a single surgery without cataract removal, but most often it is combined with cataract surgery.

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 other future traditional glaucoma surgeries that may become necessary.

What to Expect

Your surgeon will go over your current medications and advise you accordingly. The entire procedure takes between 5 to 10 minutes. 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. You will go home the same day of the surgery, but you must have a caregiver drive you home. You will generally be given antibiotics and anti-inflammatory medications, and you should avoid strenuous activities for at least one week.

Kahook Dual Blade

The Kahook Dual Blade 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. The procedure can also be combined with cataract surgery, without noticeably affecting recovery. The KDP 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, removing a section of the tissue and allowing increased aqueous flow, thereby lowering IOP.  This procedure is very similar to the Trabectome, only it uses a disposable blade instead of a electrocautery and does not require the purchase of a special cautery machine.

What to Expect

Gonitomy with the Kahook Dual Blade is an outpatient procedure and 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.

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.

Using a microstent, three of which are currently approved by the FDA, a surgeon opens the eye’s natural drainage system during cataract surgery. These specially designed stents can reduce intraocular pressure (IOP) in adult patients who are currently taking IOP medications for mild or moderate open-angle glaucoma and who have a cataract. The insertion of the stent only adds a few minutes to the surgery and is done when the cataract surgery is complete. Adding no significant additional 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. The cataract removal and microstent procedure are usually performed under local anesthesia. The cataract removal and stent implant only take 15 to 20 minutes and is performed on one eye at a time. 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 can go home the same day and will receive antibiotics and anti-inflammatory eye drops to use for several weeks after the surgery. Recovery time is brief, but your doctor will recommend that you avoid strenuous activity for at least a week.

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 of intraocular pressure. Canaloplasty is less invasive than traditional surgical procedures because it works on the surface to enlarge the eye’s natural drainage to restore normal 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.

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. Another similar surgery called the OMNI procedure attempts to restore the eye’s natural drainage in the same manner but from an internal approach to the drain as opposed to the external approach of a canaloplasty.

What to Expect

Your surgeon will numb your eye and make a small incision to place a microcatheter into your eye’s drainage canal. The microcatheter is used to enlarge the drainage canals, then it is removed. The entire procedure takes between 30-45 minutes, depending on the patient. 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 infection. You may feel a scratchy sensation in your upper eyelid for up to a few weeks from the sutures that eventually dissolve.

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.

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 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.

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.