Laser and Glaucoma Operations

by

Laser surgery for Glaucoma

Today there are innovative laser glaucoma interventions that are increasingly used instead of drugs when glaucoma drugs are not sufficient or the side effects are not well tolerated by the patient. The most innovative glaucoma laser intervention is undoubtedly Selective Laser Trabeculoplasty known as SLT, available for the last 5 years or so but still underused in Italy. The Dr. Badalà performs this laser surgery for glaucoma in Milan and Catania. Laser to treat glaucoma can be used in various ways, to avoid acute glaucoma in the case of angle-closure glaucoma by performing a Yag iridotomy Laser or in open angle glaucoma through laser trabeculoplasty surgery. Laser surgery for glaucoma called trabeculoplasty aims to facilitate the escape of aqueous humor from inside the eye and thus reduce eye pressure. Historically , Argon Laser Trabeculoplasty, also known as ALT, was performed . Today this method is superseded by Selective Laser Trabeculoplasty or SLT which is less invasive, more effective and has fewer risks. In angle-closure glaucoma, another type of laser operation called argon laser pupilloplasty is performed . <iframe width=”300″ height=”325″ src=”https://www.youtube.com/embed/58iLJJH4O-k” title=”ALT SLT (argon laser trabeculoplasty selective laser trabeculoplasty)” frameborder=”0″ allow=”accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share” allowfullscreen></iframe> However, the most common techniques of laser therapy for glaucoma are trabeculoplasty and iridotomy . In both cases these interventions do not require hospitalization. The patient goes to the eye clinic after instilling a few drops of anesthetic eye drops. You sit at the laser machine, place a lens on your eye and a series of pulses of light are directed at the areas to be treated. The operation is totally painless, there is no need to bandage the eye and after an eye pressure check the patient can go home. The success rate for selective laser trabeculoplasty is approximately 80% in the first year (ocular tone is within normal values). However, it must be remembered that the patient must still monitor himself since over time the pressure can rise again. The Dr. Badalà has been performing selective laser trabeculoplasty or SLT since 2005 when it was not yet available in Italy. Today he performs selective laser trabeculoplasty in Milan and Catania.

Surgical intervention

Glaucoma surgery is recommended to avoid damage to the optic nerve when laser therapy or glaucoma medications are not effective in lowering intraocular pressure. The most used operation in the world is Trabeculectomy. It aims to create an efficient and alternative drainage route for diseased ones, linking the space between the iris and the cornea and that located under a membrane called “conjunctiva”, which covers the eye. Trabeculectomy must be performed by an experienced surgeon. We perform local anesthesia and after the trabeculectomy the eye is bandaged and eye drops are applied for a few days . The treatment of glaucoma with this method is effective but can present complications if not performed in specialized glaucoma centers by hands with great experience. Great care must be taken not to make any efforts after trabeculectomy for at least a month because this could lead to a sudden drop in eye pressure.

After trabeculectomy, a period of abstention from activities involving physical exertion for at least thirty days is advisable unless otherwise indicated by the ophthalmologist. The Dr. Badalà performs trabeculectomy in Milan. He collaborates with the Jules Stein Eye Institute in Los Angeles on the development of new techniques for the treatment of glaucoma.

News Glaucoma surgery

Glaucoma surgery is indicated when, despite glaucoma treatment with drugs or glaucoma laser surgery, the pressure remains high and progressive damage to the optic nerve is observed. In these cases, a surgical treatment for glaucoma is established which in the first phase could be minimally invasive with a glaucoma operation such as the TRABECTOME or using modern miniaturized stents for glaucoma surgery ( Ex-PRESS, Glaukos , etc). These are the latest news for the treatment of glaucoma. The Ex-PRESS type stent is a mini stent for the treatment of glaucoma. It was developed by an Israeli company, Optonol, which in Italy had its reference center at the University of Genoa. The Dr. Badal began his experience with Ex-PRESS in 2001. He published some important scientific works on this stent for the treatment of glaucoma several years ago.

The TRABECTOME is a device for the treatment of glaucoma which allows the removal of the major obstacle to the outflow of aqueous humor represented by the trabecular meshwork. This is performed while maintaining the anatomical integrity of the eyeball and without creating a new communication between the inside and outside of the eye.
The Dr. Badalà is the first Italian to have performed glaucoma surgery with Trabectome in 2007 and has extensive experience with this technique which aims to eliminate the obstacle to the escape of aqueous humor from the eye by eliminating the trabecular meshwork with an ab interno approach. Minimally invasive glaucoma surgery has the advantage of having fewer complications than major glaucoma surgery. However, its effectiveness is often less than the standard glaucoma surgery which is Trabeculectomy . Dr. Badalà performs this type of surgery for the treatment of glaucoma in Milan and Catania.

Drainage valves (Ahmed)

In advanced glaucoma or when trabeculectomy fails, the most suitable therapy is glaucoma surgery with the implantation of draining valves such as the Ahmed valve (the most widespread). Other draining valves are the Molteno shunt or the Baerveldt plant. They allow, by inserting a small drain tube into the eye, to keep the eye pressure at acceptable levels. These types of operations are performed only by those who have acquired experience in specialized glaucoma centers. The Dr. Badalà performs this type of operation for the treatment of glaucoma only in Milan. Ahmed’s valve should be reserved for particularly complex cases that are refractory to other therapies. Ahmed valve implantation is often required in patients with Boston Artificial Cornea.

Finally, let us remember that when this glaucoma treatment also fails there are other options which however affect the functionality of the eyeball such as cryotherapy of the ciliary body .

Glaucoma: Costs and conventions

Glaucoma surgery in convention

Laser glaucoma surgery ( SLT or selective laser trabeculoplasty ) as well as trabeculectomy and other minimally invasive surgeries to treat glaucoma they can be carried out in agreement with the main insurance companies , supplementary funds and health funds. Some insurances provide direct payment of the medical service without any cost to the patient, others provide indirect assistance . Each insurance has its own price and reimbursement schedule. In this case the patient will receive a refund after presentation of the invoices for the services received.