Glaucoma Surgery and Treatment
Dr Osmanovic is fellowship trained glaucoma surgeon that specializes in the medical, laser and surgical management of glaucoma. He treats patients within the practice as well as complex glaucoma cases referred from other eye care providers.
The goal of glaucoma treatment is to preserve your vision by lowering the intraocular pressure to safe levels. Target intraocular pressure is individual for each patient based on the severity of glaucoma, life expectancy, existing pressure and associated risk factors. Pressure control may be achieved with a combination of eye drops, oral medications, laser treatments and surgery.
Laser surgeries for glaucoma either increase the outflow of the fluid from the eye in open-angle glaucoma or eliminates fluid blockage in angle-closure glaucoma.
Laser trabeculoplasty is procedure that utilizes laser energy to improve the drainage function of the eye and is used to treat open-angle glaucoma. An older type of trabeculoplasty surgery is called argon laser trabeculoplasty (ALT) and consists of making small, evenly spaced burns in the eye’s drainage system. A newer type of trabeculoplasty is known as selective laser trabeculoplasty (SLT) in which a low level energy laser is used to target specific cells in the drainage channels using short laser pulses. SLT is an office-based, minimally invasive procedure with no pain, scarring or significant side effects that has been shown to lower pressure at rates comparable to ALT. There is increasing evidence that early laser surgery may be better initial treatment for some people with glaucoma than the use of medications.
Laser iridotomy is an office-based procedure used for treating patients with angle-closure glaucoma as well as patients with very narrow drainage angles. Using a special type of laser, a tiny hole is created through the top part of the iris to allow free flow of aqueous fluid to the drainage angle. Laser iridotomy is sometimes done as an emergency procedure in an attack of angle-closure glaucoma but more often as a preventive measure against angle-closure in patients with anatomically narrow angles.
Laser cyclophotocoagulation is a procedure in which a special type of laser beam is used to reduce fluid production in the eye with glaucoma by destroying the fluid producing tissue. It is usually done in patients with poor vision and who are poor candidates for other types of glaucoma surgery.
Glaucoma microsurgery is usually undertaken when glaucoma is not adequately controlled with medical and laser therapy. Surgery consists of creating a new drainage channel to drain the fluid from inside the eye thus reducing the intraocular pressure.
Trabeculectomy is the most commonly used incisional surgery for glaucoma. It is done in the operating room under anesthesia. During surgery a path (fistula) is created under a small flap in the eye wall and a filtration bleb is created under the conjunctiva. The fluid from inside the eye passes through the fistula and accumulates in the bleb where it is absorbed into surrounding blood vessels. A filtration bleb looks like a small blister on the white part of the eye underneath the upper eyelid. To prevent scarring of the filtration bleb and fistula closure antifibrotic medications may be used during and after surgery.
Glaucoma shunt surgery is usually performed if trabeculectomy is not possible, although recent studies show that a shunt may be a better initial surgery for certain forms of glaucoma. A glaucoma shunt is a small plastic tube or valve implanted in the front portion of the eye and connected to an extraocular reservoir located under the conjunctiva. The fluid is directed through the tube from the inside of the eye to the reservoir and then absorbed into surrounding blood vessels. The reservoir is located far from the front part of the eye is not easily noticeable.
Combined cataract and glaucoma surgery is indicated in certain patients with glaucoma who develop cataracts and require surgery to improve vision reduced by the cataract. Cataract surgery is combined with trabeculectomy in patients who have both cataract and severe glaucoma or glaucoma uncontrolled with medical and laser therapy.
In patients with mild or moderate open-angle glaucoma, cataract surgery may be combined with a one of several novel microincisional glaucoma surgeries (MIGS). In our practice Dr Osmanovic offers the iStent® Trabecular Micro-Bypass as a surgical option to reduce eye pressure in patients with both cataracts and glaucoma. iStent creates a permanent opening through the blocked drainage system of the eye to improve the outflow of fluid through the eye’s natural outflow system. iStent is the smallest medical device implanted in the body and it functions similarly to the stents used in cardiology to prevent heart attacks.