Emerging Glaucoma Treatments

Through extensive clinical research and trials, doctors and researchers have created several 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.

Shunt Surgery- Mini Glaucoma Shunt

Medicated eye drops are sometimes insufficient in lowering intraocular pressure (IOP). If this is the case, your doctor may encourage you to consider glaucoma filtration surgery.  Traditional glaucoma filtration surgery is called trabeculectomy, which has been performed for more than 30 years. Trabeculectomy involves making a small hole in the sclera (white of the eye) to create a new opening for fluid to exit the eye.

A newer glaucoma treatment is called the Ex-Press mini glaucoma shunt. The mini-shunt is an alternative to a larger silicone tube shunt or a repeat trabeculectomy. About the size of a grain of rice (3mm), the mini-shunt has a spur-like extension on one end and an external disc at the other. The shunt is a simple method of filtration for open-angle glaucoma and lowers IOP by routing aqueous humor from the anterior chamber of the eye. Made of stainless steel, the mini-shunt is placed in the anterior of the eye under a scleral flap. The shunt diverts a controlled amount of fluids through a small tube to the outside of the eye to maintain the correct IOP. The area of drainage is covered by the eyelid and is not visible.

Preparing for Shunt Surgery

Your surgeon will go over your current medications and advise you accordingly. If you are taking blood thinners such as Coumadin, Plavix or aspirin, you will have to get your Coumadin levels checked two weeks before the procedure and will likely have to discontinue use of all blood thinners prior to surgery. Your surgeon may ask you to stop taking certain medications before surgery and will advise you when you may safely resume taking them again.

What Happens During Shunt Surgery?

Mini-shunt surgery can be done under local or general anesthesia. After anesthesia is administered, your surgeon will use an injection system to implant the shunt. A metal rod is fitted into the lumen of the shunt and is attached to the end of an injector. Your surgeon will make a small flap in your sclera, (similar to the flap for a trabeculectomy) and angle the shunt into the opening. The injector is depressed and the metal rod is placed into the eye. Your surgeon will then suture the opening in the sclera and overlying conjunctiva.

The entire procedure takes about 45 minutes, and you can return to work anywhere from 2 to 7 days after the procedure.

What Happens after Shunt Surgery?

Shunt surgery is an outpatient procedure and most patients can go home the same day, although you need a caregiver to provide transportation. You probably will not experience much pain after the surgery except for possibly a bit of discomfort from the dissolvable sutures. It is typical to be seen by your doctor the day after, a week after your procedure and a month after your procedure. After that, quarterly appointments are recommended appointments should be made at your doctor’s discretion.

You will be given antibiotics, anti-inflammatory medications and sometimes laxatives to take after the surgery. It is important that you do not have any constipation or straining because this will increase eye pressure. You may even wear an eye shield at night. During the recovery period, you should avoid strenuous activities and sports as well as lifting, bending and straining. Most patients can return to work within about a week.

What are the Outcomes of Shunt Surgery?

The mini-shunt takes effect immediately, and eye pressure should stabilize within the first four weeks. The mini shunt is safer than trabeculectomy and often eliminates the need for glaucoma eye drops. Studies have found fewer post-op complications in mini-shunts compared to trabeculectomy. Patients also experience a faster recovery of visual acuity.

Trabectome

If you have glaucoma as well as a cataract, you may be a good candidate for Trabectome surgery. Trabectome is a new, probe-like device that is inserted into the anterior chamber of the eye through the cornea and opens the eye’s drainage system.

Forms of open-angle glaucoma can be treated with Trabectome. This surgery can be performed as a single surgery without cataract removal, but most often it is combined with cataract surgery. There are two common scenarios for Trabectome:

  • Your glaucoma is your primary eye issue but you also have a cataract. Your glaucoma is not effectively controlled with eye drops or laser.
  • Cataracts are your primary eye issue, but you would also like to reduce your use of eye drops for glaucoma.

Preparing for Trabectome

Your surgeon will go over your current medications and advise you accordingly. If you are taking blood thinners such as Coumadin, Plavix or aspirin, you will have to get your levels checked two weeks before the procedure. Your surgeon may ask you to stop taking certain medications before surgery and will advise you when you may safely resume taking them again.

What Happens during Trabectome?

The entire procedure takes between 5 to 15 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. The probe delivers thermal energy to the trabecular meshwork of the eye. This allows the aqueous humor to flow more freely and lowers the intraocular pressure (IOP).

What Happens after Trabectome?

You will go home the same day of the surgery but you must have a caregiver drive you home after the procedure because the medication causes extreme drowsiness. The day following the surgery, you will visit your eye doctor to be examined for inflammation or infection. You may be given antibiotics and anti-inflammatory medications to prevent infection.

For at least one week, you should avoid strenuous activities such as heavy lifting or bending down. Some patients experience clearer vision the following day, but other patients may require several days to improve. While you wait for your vision to sharpen, you may need to refrain from driving or operating equipment.

What are the Outcomes of Trabectome?

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

Usually, you will stop glaucoma drops immediately after the surgery and gradually add the drops in later months, later if necessary.

Micro Invasive Glaucoma Surgery with Cataract Surgery

In the past, glaucoma and cataract surgery were two separate procedures. Recently, there have been new developments in less invasive procedures called Micro-Invasive Glaucoma Surgery (MIGS) which allow patients to simultaneously have glaucoma and cataract surgery. Using a microstent the size of an eyelash, a surgeon can open the eye’s drainage system during cataract surgery. Most patients with a cataract and open-angle glaucoma are good candidates for this procedure.

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 also have a cataract. The cataract portion of the surgery improves clarity of vision and the microstent helps control glaucoma. The insertion of the stent only adds a few minutes to the surgery and is done when the cataract surgery is complete. Adding no additional risk to the procedure, the microstent can help greatly in the control of IOP and can reduce the number of medications (which usually are accompanied by side effects) that you are taking.

The tiny stint creates a permanent opening in your trabecular meshwork and helps improve the flow of fluid from your eyes to regulate intraocular pressure (IOP). Essentially, it acts as scaffolding that opens and enlarges the drainage system. There are many advantages of MIGS. This procedure:

  • Protects eye tissue that often gets damaged by traditional surgeries
  • Can be safely implanted during cataract surgery
  • Has a rapid recovery time
  • Allows for future treatment options for preserving vision

Preparing for MIGS

You should continue using any prescribed eye drops until your operation, unless otherwise directed. Your surgeon will go over all your medications, especially if you take blood thinners such as Coumadin. Bring a list of your current medications and a brief medical history to your pre-operative appointment. Your surgeon may recommend that you stop taking certain medications about a week before the surgery and will also advise when you can resume taking your medications again.

What Happens During MIGS?

The cataract removal and microstent procedure are usually performed under local anesthesia. Your surgeon will first perform the phacoemulsification operation to remove the cataract. With 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 stent will be inserted by a preloaded, single-use, sterile applicator. Your surgeon will slowly advance the stent into the trabecular meshwork of your eye and push the button on the inserter to release the device. The cataract removal and stent implant only take about 15 to 20 minutes per eye.

What Happens After MIGS?

MIGS is an outpatient procedure, and you can go home the same day. After the surgery, your eye will be covered by an eye shield that you can remove the following morning. You will receive antibiotics and anti-inflammatory eye drops to use for the next 4 to 6 weeks. Most likely, you will see your ophthalmologist the following day.

Recovery time is quite brief, but your doctor may recommend that you take an entire week off from work. You should refrain from strenuous activities like sports, lifting heavy objects or straining as this will increase your eye pressure.

What are the Outcomes of MIGS?

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 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.

Canaloplasty

Canaloplasty is a breakthrough, 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. Similar to angioplasty, canaloplasty enlarges the eye’s natural drainage to restore the eye’s natural irrigation. It is less invasive than other surgical procedures because it does not go into the eye but works on just the surface tissue without creating a full thickness hole in the eye.

Canaloplasty is effective with patients with open-angle glaucoma, especially in patients who have a higher risk for infection or bleeding, or patients who are at higher risk of complications with trabeculectomy

Preparing for Canaloplasty

Your surgeon will go over your current medications and advise you accordingly. If you are taking blood thinners such as Coumadin, Plavix or aspirin, you will have to get your levels checked two weeks before the procedure. Your surgeon may ask you to stop taking certain medications before surgery and will advise you when you may safely resume taking them again.

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 remove the microcatheter and use sutures to keep the drainage canals open.

The entire procedure takes between 45 minutes to 2 hours, depending on the patient.

What Happens After Canaloplasty?

Canaloplasty is an outpatient procedure and you will go home the same day. However, you 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. This feeling is from the sutures that eventually dissolve.

Canaloplasty does not cure glaucoma but it slows the progression of the disease. Some patients are able to stop using glaucoma drops after canaloplasty.

What Are the Outcomes of Canaloplasty?

There are several benefits to canaloplasty compared to other glaucoma surgical procedures:

  • Most patients regain visual acuity rapidly
  • Often, visual recovery is faster with canaloplasty compared to other glaucoma surgical procedures
  • Because it is minimally invasive, there is lower risk of complications and scarring
  • There may be fewer post-operative visits  and fewer restrictions following surgery
  • Patients are still eligible to have traditional glaucoma surgery after canaloplasty

Talk to your doctor to see if one of these innovative procedures will help preserve your vision. Breakthrough technology, along with traditional methods, can help keep your vision clear and prevent your glaucoma from advancing. Contact one of our treatment centers to make an appointment, or click here to locate a treatment center near you.