When to operate Glaucoma?

Which is the best treatment for glaucoma?

Glaucoma treatment is mostly intended to lower the ocular pressure, to diminish the damage to the optic nerve. Ocular pressure in fact, is the main factor that can be changed when curing glaucoma. Today there are several therapies to cure glaucoma:

• Glaucoma therapy with medications: it consists in ocular drops of different categories that contain beta blockers, like prostaglandine, alpha adrenergic agents, myotics, anhidrido carbo inhibitors, topical or in pill form. These drugs reduce the acqueous humor production, or improve its discharge through the camerular angle.
• Glaucoma Laser Therapy: improves the drainage through the camerular angle, lowering the endocular pressure.
• Glaucoma surgery: glaucoma surgery creates a new passage for acqueous humor drainage. Surgery is meant for glaucoma cases that cannot be easily monitored with a local therapy, nor with a proper laser treatment.

Therapy strenght depends on the optic nerve condition, the patient’s age and other subjective variables.

The choice between glaucoma surgery, minimally invasive surgery, laser or medications, depends on the optic nerve condition and the patient’s life expectancy.

A glaucoma specialist that has experience on every option for glaucoma treatment will advice you on the best choice for your case.

When to operate Glaucoma

Today glaucoma surgery is performed when the patient cannot tolerate medications or eye drops are not enough to stop the disease. The first kind of surgery is laser. The most innovative glaucoma laser surgery is the Selective Trabeculoplasty, known as SLT, available from the last 5 years but still not in use in Italy.

Dr. Badalà performs this glaucoma laser surgery in Milan and Catania. This surgery called Trabeculoplasty, is meant to ease the acqueous humor discharge from the inside of the eye, lowering the eye pressure.

Historically, there was a surgery called Argon Laser Trabeculoplasty, also known as ALT. Today, it is overrated: the most innovative surgery is the Selective Laser Trebaculoplasty or SLT, that is less invasive, more effective and has less risks. Surgery in case of glaucoma is suggested when medication therapy or laser treatment prove to be non effective, eye pressure remains high and there is a progressive damage for the optic nerve.

In these cases, it is suggested a surgical therapy that can be minimally invasive in its initial phase, like the TRABECTOME or with the modern miniaturized stents for glaucoma surgery (Ex-PRESS, Glaukosetc).

Dr. Badalà has been the first in Italy to ever perform glaucoma surgery with Trabectome in 2007. Mini stent in glaucoma surgery have the advantage of having less complications if compared to major glaucoma surgery. Anyway, they can be less effective than the standard glaucoma surgery that is the Trabeculectomy (see illustration).

If Trabeculactomy fails too, the next step in glaucoma surgery consists in surgery with draining implants like the Ahmed valve or the Molteno shunt, or also the Baerveldt implant (this consists in the implant of a small tube for drainage, keeping the ocular pressure at acceptable levels).