Glaucoma is a serious eye disease that can lead to complete loss of vision. At an early stage of pathology, doctors use conservative therapy. However, this does not always give the desired effect. In such complex cases, it is necessary to resort to surgical treatment of glaucoma. This is often the only way to prevent blindness. In the article we will consider in detail the main types of operations, the methodology for their implementation and the features of the rehabilitation period.
Pathology Description
The term "glaucoma" in ophthalmology means a group of diseases that are accompanied by high intraocular pressure, visual impairment and atrophic changes in the optic nerve. Such pathologies are more common in older people, but the occurrence of the disease at a young age cannot be ruled out.
In the chambers of the eye, fluid is constantly being produced. If its outflow is disturbed, then the patient's pressure inside the organ of vision increases. In this case, the optic nerves are compressed. In humans, visual impairment progresses. Ophthalmologists call this disorder glaucoma. The following forms of pathology are distinguished:
These two types of disease differ in the mechanism of violation of the outflow of fluid from the eye chambers. Angle-closure glaucoma is considered a more severe form of pathology.
With glaucoma, doctors prescribe drops to patients to reduce pressure inside the eye, as well as drugs to improve blood circulation and metabolism in the organ of vision. These medicines have to be used constantly. If the medications do not work, then patients are shown vision correction with a laser.
However, drug therapy does not always lead to the desired result. In this case, surgical treatment of glaucoma is indicated. When choosing a method of operation, the form and stage of the pathology are taken into account.
When surgery is needed
Is it worth doing an operation on the organ of vision? This question often worries patients. Surgical intervention is necessary if the patient has the following indications for the surgical treatment of glaucoma:
- The lack of effect from the use of drops. If after a course of drug therapy the patient has high intraocular pressure, then his condition can be improved only with the help of surgery.
- The narrowing of the fields of vision. This is a sign of damage to the optic nerve. In such cases, the patient's vision can only be saved surgically.
- Failure to follow the instructions of an ophthalmologist. The operation is also shown if patients, due to senile age or for any other reasons, are not able to instill medication into the eye on their own.
Often, patients themselves express a desire to be treated surgically. Thus, they want to get rid of the need for continuous use of drops, which have many side effects. In such cases, only an ophthalmologist can assess the need for surgery.
Glaucoma is usually chronic. But sometimes there is an acute form of the disease, in which blindness can occur within a few days. With such a rapid development of pathology, the patient needs emergency surgery.
Varieties of operations
Currently, the following types of surgical treatment for glaucoma are used in ophthalmology:
- iridectomy;
- trabeculectomy;
- drainage;
- cyclodialysis;
- sclerectomy.
Which of the following operations is most effective? This question is hard to answer. After all, each type of surgical intervention has its own indications. Much depends on the form of pathology, the danger of loss of vision and the general condition of the patient. Only a specialist can evaluate all these factors.
Next, we will consider in detail the main types of surgical treatment for glaucoma and the consequences of operations.
Preparation period
A patient with an acute form of the disease and progressive blindness is operated on an emergency basis. In this case, there is no time left to prepare for the intervention. The main task of doctors is to urgently restore the outflow of fluid from the eye chambers and save eyesight.
In the chronic form of the disease, the operation is performed as planned. The following preparation for the surgical treatment of glaucoma is required.
- Before the operation, the patient undergoes a comprehensive diagnosis. The fields and visual acuity are examined, several times the pressure inside the eye is measured. Also, the patient is prescribed laboratory tests.
- A week before the operation, the patient needs to stop using drops from increased intraocular pressure. Otherwise, surgery will not give the desired result. It is also forbidden to take blood thinners. Only antibacterial eye drops are allowed.
- On the day of surgery, you should refuse to eat.
Surgical treatment of glaucoma in the elderly has its own characteristics. A week before surgery, sedatives are prescribed to such patients. This provides a sound sleep and a calm psychological state before the intervention.
Surgical treatments for glaucoma are used only in inpatient settings. The patient is admitted to the hospital the day before surgery. The length of stay in the hospital depends on the type of intervention and the characteristics of the course of the rehabilitation period.
Iridectomy
This surgical method for the treatment of glaucoma is used in the closed-angle form of pathology. The operation is performed on the iris. It is in this area that fluid transitions from the posterior chamber of the eye to the anterior one.
If the angle of the anterior chamber is closed, then the outflow of moisture is disturbed, and intraocular pressure increases. This is noted with a closed-angle form of pathology. Iridectomy allows you to open or expand the angle of the anterior chamber.
This operation does not require the use of general anesthesia, it is performed under local anesthesia. The surgeon cuts the conjunctiva, removes the sclera and opens the anterior ophthalmic chamber. Then the doctor removes a small area of the iris and sutures. Thus, the angle of the chamber opens, and normal outflow of fluid is restored.
If it is necessary to expand the angle of the chamber, then the operation is carried out in a slightly different way. The doctor using a spatula separates the ciliary body. This leads to the expansion of the closed angle and the normalization of the removal of moisture. Then the anterior ophthalmic chamber is filled with air and sutured.
Sutures are removed after 7-10 days with any method of iridectomy.
Trabeculectomy
This is the most common surgical treatment for glaucoma. Recommended for patients who have very weak own drainage system of the eye. During the surgical procedure, ways are created to drain the fluid (fistula).
The doctor introduces a local anesthetic to the patient and makes an incision in the conjunctiva and sclera. Then the doctor excises the trabeculae (part of the drainage system of the eye) and removes the obstacle to the removal of moisture. In some cases, an iridectomy is performed simultaneously.
After creating a fistula, drops are administered to the patient to dilate the pupil. This causes temporary visual impairment, but is necessary to monitor the condition of the eye.
Such surgical treatment of glaucoma has its advantages and disadvantages. In 85% of cases, the patient returns to normal intraocular pressure. However, in a small part of patients, the created channel undergoes cicatricial changes over time. It is no longer possible to restore its patency by surgery. Also, the consequence of the operation can be a violation of the nutrition of the lens and the development of cataracts.
Drainage
This operation is carried out with the inefficiency of creating a fistula. Tubes for fluid drainage are placed in the eye chamber. In some cases, special valves are introduced that open when pressure rises.
Drainage operations help even in advanced cases. There is no risk of developing cicatricial changes. Nowadays, tubes and valves are made of modern high-quality materials. Drainage devices do not overgrow and maintain patency for a long time.
Cyclodialysis
This operation is indicated for patients with an uncomplicated form of pathology. With the help of a spatula, the surgeon exfoliates part of the vascular tissue from the sclera. This creates a channel for the removal of moisture.
After surgery, hemorrhage in the anterior chamber of the eye may occur. However, it resolves on its own and does not pose a risk to the health of the patient.
Sclerectomy
This type of surgical treatment for glaucoma is rarely used. During the operation, the doctor removes part of the outer ocular membrane. Intervention is indicated with an open-angle form of pathology.
However, after a sclerectomy, patients often develop fibrotic changes in the eye tissues. Therefore, you have to do repeated operations very often. Today, there are more effective and safer types of surgical interventions.
Effects
In some cases, postoperative complications occur. Therefore, careful monitoring of the patient after surgical treatment of glaucoma is necessary. The following pathologies can be the consequences of the operation:
- choroid detachment;
- excessive decrease in pressure inside the eye;
- scarring and fistula overgrowth;
- inflammatory processes in the structures of the organ of vision;
- bleeding into the anterior chamber.
These complications are treatable. Of great importance is the timely diagnosis of arising pathologies. Most often, the negative effects of operations are noted in people over the age of 75 years.
Rehabilitation
After the operation, the patient is in the hospital under the supervision of a doctor, and after discharge, he regularly comes to the ophthalmologist for examinations.
In the postoperative period, you must adhere to the following rules:
- Cover the operated eye with a bandage for several days.
- For the first week after the intervention, avoid eye strain, refuse to watch television and work on the computer.
- Within 10 days, protect your eyes from water and do not shower.
- Observe the gentle regime and do not subject yourself to physical activity.
- In bright light, wear sunglasses.
- After surgery, it is strictly forbidden to drink alcohol and salty foods.
After the operation, doctors prescribe eye drops with antibiotics and corticosteroids. This helps prevent inflammatory complications. It is necessary to carefully adhere to the prescribed treatment regimen.
Forecast
How effective is surgical treatment of glaucoma? After surgery, remission occurs in 90% of patients. Intraocular pressure returns to normal. This effect persists for 5-6 years. If the patient was given artificial drainage, then the pressure is kept within the normal range for about 2 years. After this period, repeated surgical treatment is required.
However, even after a high-quality operation, new obstacles may form for fluid drainage. It is not yet possible to avoid such consequences of glaucoma. In addition, in elderly patients, high pressure inside the eye can be combined with cataracts. In this case, it is necessary not only the surgical treatment of glaucoma, but also the replacement of the lens.
If with glaucoma the patient partially lost his sight, then it can no longer be restored. Indeed, with this disease, photosensitive cells die, and this is an irreversible process. The operation only helps to stop the pathology and prevent further visual impairment.
Where do the operations
Surgical treatment of glaucoma in Moscow is carried out in ophthalmology departments of hospitals or specialized eye hospitals. For citizens of Russia free operations on the compulsory medical insurance policy are possible. For this, it is necessary to have a referral from the attending ophthalmologist on hand, as well as the results of laboratory tests and instrumental examinations. Scheduled operations are carried out according to the quota, that is, in the order of priority.
In acute form of glaucoma, the patient needs urgent surgery. Procrastination threatens him with a loss of vision. In such cases, the ambulance team takes the patient to the hospital. Surgery is carried out in an emergency.
Surgical treatment of glaucoma in Moscow is also carried out in private clinics. The price of the operation may be different. The average cost of surgical treatment is from 20,000 to 45,000 rubles. The most expensive type of operation is the installation of drainage with a tank for outflow of moisture.
Patient opinion
You can find many positive reviews about the surgical treatment of glaucoma. After the operations, the intraocular pressure returned to normal, the sclera pain and the vision of the rainbow circles in the field of vision disappeared. Patients note that they have become much less tired eyes. Most patients have impaired vision impairment.
Judging by the reviews, the operations are almost painless. During surgical interventions, powerful local anesthetics are used. A slight discomfort occurs in the postoperative period, but the discomfort quickly stops with special drops.
Negative reviews are mainly due to the fact that the operation did not help patients regain their lost vision. It is important to remember here that with glaucoma an irreversible damage to the internal structures of the eye occurs. Therefore, to restore vision is no longer possible. Surgical treatment only helps to stop further damage to the optic nerve.
Ophthalmic surgery for glaucoma has its advantages and disadvantages. They effectively reduce intraocular pressure and help to avoid blindness. However, surgical interventions lead only to temporary remission. They must be repeated every few years.