Selective Laser trabeculoplasty SLT

It is a laser to lower the eye pressure which is a procedure which is carried in a clinic setting. It lowers the eye pressure by enhancing outflow of the fluid inside the eye through the natural drainage system. It is a pain free, quick procedure, it often produces an effective lowering of eye pressure. It can be used as first line therapy or as an addition to your glaucoma eyedrops.

Glaucoma filtration surgery

In cases of moderate to severe glaucoma we might consider filtration surgery when a significant eye pressure lowering is required. Filtration surgery works by creating an extra outflow channel in the eye allowing the fluid to escape to the subconjunctival space (under the outer coat of the eye).

Trabeculectomy is the most known glaucoma drainage operation which is a very successful operation in terms of eye pressure lowering and percentage of success.  Trabeculectomy involves a drainage channel created at the top of the eye under a scleral flap (white of the eye).  The flap is then secured using very fine releasable sutures. This level is tailored to your condition. Surgery is usually performed under local anaesthetic or general anaesthetic. Following the surgery patients are monitored initially on a weekly basis in order to adjust the pressure as we might remove the releasable sutures to gradually open the drainage flap and gauge the eye pressure down to the desired eye pressure.

An example of Trabeculectomy

Aqueous shunt

Also known as tube surgery, this is usually for more complicated types of glaucoma. Tube surgery is used when previous glaucoma surgery has failed or where it is deemed that other surgeries are not suitable. Baerveldt tube, Paul tube and Ahmed valve are the devices designed to divert fluid from inside the eye to the subconjunctival space.  This surgery requires you to have a donor/artificial grafts.

Angle surgery and MIGS

There are now many surgical options in the treatment of glaucoma. Many of them focus on enhancing the outflow system through the natural drainage channels. The resistance can be bypassed by inserting a small titanium stent in the form of the Glaukos iStent or the Ivantis Hydrus stent. 

The internal drainage channel can also be dilated using a technique called ab internal canaloplasty (Abic) using new innovative technologies as iTRAC and OMNI

All of these procedures are called minimally invasive glaucoma surgery(MIGS) with reduced risk profile. And effective treatment in certain cases. The lowering of the eye pressure is often sufficient for patients suffering from mild to moderate glaucoma. MIGS can be performed on its own but more often are combined with cataract surgery to achieve the maximum eye pressure lowering effect.

Goniosynicholysis is used in closed angle to try to release the adhesions from the angle to give a chance to the natural drainage to work on its own, this is only used in narrow/closed angle glaucoma.


Other types of Lasers

External and Endoscopic cyclodiode laser

Another type of laser used in certain glaucoma conditions to lower the eye pressure, it is usually performed under local anaesthetic at the operating theatres.