Treatment for glaucoma

Damaged fibers of the optic nerve cannot be substituted in any way. Therefore at the moment glaucoma cannot be treated and the only thing we can do is to slow down or stop its further progress. The more damaged is the optic nerve at certain intraocular pressure and the more fibers which are dead then it is even more important to decrease intraocular pressure. Depending on how significantly we need to decrease intraocular pressure, we can opt for conservative, laser or surgical treatment of glaucoma. Eye drops are capable of decreasing it very slightly but surgery has usually higher effect.

Goals of the treatment for glaucoma

To stop the progress of damage to visual functions
To decrease intraocular pressure to the value of “target pressure”
To minimize side effects and complications during the glaucoma treatment

Types of glaucoma treatment:

Conservative treatment for glaucoma
Laser treatment for glaucoma
Surgical treatment for glaucoma

Glaucoma therapy begins with conservative treatment. Laser and surgical treatments are being considered only when conservative treatment does not bring desired results. However, treatment procedure varies individually from patient to patient.

Conservative treatment for glaucoma

In this type of treatment a patient uses medical substances which decrease intraocular pressure, improve blood flow through the optic nerve, improve hemodynamic parameters and prevent apoptosis. Prescription of medications with side effects must be considered for each patient individually and a doctor must take into consideration patient´s safety and the quality of life.

These medications are most often applied on daily basis in form of eye drops. Depending on the type of prescribed medication, eye drops can be applied several times a day or once a day. There are also certain gels available which liquefy after they are applied to the eye and are as effective as eye drops. Under certain circumstances the use of gel can be more comfortable and its effect can be long-term. In some cases eye drops can be supplemented with pills.

Substances which decrease production of the intraocular fluid - the goal of application of these eye drops is to reduce the amount of production of the intraocular fluid to such a degree that it will not radically grow in its volume and it will prevent any increase in intraocular pressure.
Substances which influence drainage of the intraocular fluid - the main goal of this type of eye drops is to improve drainage of the accumulated intraocular fluid.
Hyperosmotic substances - they are prescribed in urgent states and in the cases where it is necessary to immediately decrease extremely high intraocular pressure.

Laser treatment for glaucoma

When eye drops cannot effectively decrease intraocular pressure then a doctor can try to facilitate drainage of the aqueous humour by laser ray. However, the effect is usually temporary and at the moment laser method is used only as supplementary treatment.

Laser treatment is less traumatizing than surgical procedure. Laser procedure can be performed also under ambulatory conditions. The use of local anesthesia is sufficient. Laser is a suitable option if a patient has an allergy to medications or if a surgery is unsuitable due to various reasons.

Laser trabeculoplasty

Laser trabeculoplasty (LTP) is a middle degree between ineffective pharmacotherapy and surgical procedure. The photocoagulation effect of argon laser trabeculoplasty is used to facilitate drainage of the fluid in the case of open-angled glaucoma.

Selective laser trabeculoplasty

Selective laser trabeculoplasty (SLT) uses low-energy short light impulses. Laser affects only excessively pigmented cells in the retina with high content of melanin, other cells remain unaffected and the architecture of the retina is preserved. SLT is more effective method than LTP.

Goniophotocoagulation

The goal of the goniophotocoagulation is the construction of newly formed peripheral iridic blood vessels and prevention of events which lead to formation of neovascular glaucoma. Danger of greater hemorrhage is a disadvantage of this method.

Cyclophotocoagulation

Neovascular glaucoma is the indication. The destruction of processes of the ciliary body leads to reduction in secretion of the intraocular fluid.

Laser sclerostomy

Laser sclerostomy represents a transition between laser and classic filter surgery. Filter channel of the full size of the sclera is formed with the help of a laser.

Surgical glaucoma treatment

Eye surgery is inevitable when previous methods are not suitable or successful. The essence of most of the surgeries lies in the creation of tiny passages in the wall of the eye which serve to drain the fluid under the conjunctiva in the case of high intraocular pressure. This will result in tiny cushion situated on slightly lifted conjunctiva which tends to be covered by upper eyelid. The creation of opening in the iris which facilitates the flow of the fluid is also a part of the surgery.

The main goal of the eye surgery is to stop the progress of glaucomatous damage of the optic nerve. Surgical procedures can be performed under ambulatory conditions or during short stay in a hospital.

Trabeculectomy

Nowadays trabeculectomy is the mostly used method in surgical glaucoma treatment. It leads to improvement of drainage of the intraocular fluid.

Deep sclerectomy

Deep sclerectomy is an alternative method to classic filter surgeries. There is a decreased occurrence of postoperative complications and it has a success rate of around 70%.