Advanced Management of Glaucoma

Glaucoma is the second leading cause of blindness worldwide and remains a significant problem with very less curative options. The recent scientific research has been trying to develop pharmacological agents and surgical procedures to control intra ocular pressure but vision loss associated with glaucoma still remains a challenge.

There are new surgical approaches that utilize advanced technology and provide better outcomes to glaucoma patients. But as they are recently developed, their long term safety and efficacy remains a question as compared to existing and proven surgical treatments for glaucoma. These newer approaches are being evaluated by glaucoma treatment professionals.

New Surgical Approaches

1. Micropulse Laser Trabeculoplasty (MLT)

Micropulse laser trabeculoplasty (MLT) is the latest laser technique that has the same pressure-lowering effects as argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). MLT uses specific diode laser (IQ 810 and IQ 532) that have much longer pulse length but slow rising temperature that delivers energy in short microbursts and allow cooling between applications.

Advantages of MLT over SLT

1. • Good results on early-stage glaucoma
   • Utilizes less energy
   • Causes less inflammation
   • Laser energy is delivered in short microbursts over an extended period of time
   • Minimum spikes in eye pressure
   • Allows tissue cooling between each pulse and reduces thermal build-up
   • No detectable tissue damage
   • No significant complications
   • 60% of patients achieve greater than 20% IOP lowering
   • Reduces the need for IOP-lowering medications

2. Canaloplasty

Canaloplasty is an FDA approved procedure of insertion of Canaloplasty micro-catheter into the drainage system canal of the eye through a small incision in the eye. The micro-catheter is used to circle and enlarge the canal so that the aqueous fluid can drain properly. After enlarging the canal, micro-catheter is removed and a suture is placed within the canal to keep it open. This procedure lowers the eye pressure by restoring the eye’s drainage system.

Advantages of Canaloplasty

1. • Restores the natural drainage pathway to reduce elevated intraocular pressure
   • Treats open-angle glaucoma
   • Less risk of complications such as infection, leakage, and irritation
   • Can be performed in patients who wear contact lenses
   • Treat children born with congenital glaucoma
   • Is safe and minimal invasive procedure with least post-operative follow-up and faster recovery time

3. Trabectome Surgery

Trabectome® is an FDA approved procedure performed through a small incision and increases the flow of fluid into the drainage system of eye to balance intraocular pressure. Eye’s drainage system is opened with the pulse from an electrosurgical hand-piece. The surgery does not require leaving a permanent hole in the eye wall or creation of an external filtering bleb (fluid collection on the outside of the eye) or an implant.

Advantages of Trabectome surgery

1. • Minimally invasive procedure
   • Out-patient procedure
   • No need of hospitalization
   • Patient can go to home the same day
   • Quick recovery
   • Effective in lowering the IOP in almost all forms of glaucoma: open-angle glaucoma and angle-closure glaucoma, as well as controlled uveitic glaucoma
   • Lowers the eye pressure by about 30%
   • Decreases the number of glaucoma eye drops

4. The Ex-Press Mini Shunt

The Ex-Press Mini Shunt is a very small stainless steel device that standardizes the trabeculectomy surgery by giving precise control on the amount of fluid allowed to flow out of the eye. The use of this device reduces the chance of the eye pressure getting too low in the immediate post-operative period to maintain a healthy level of internal pressure.

Advantages of Ex-Press Mini Shunt

1. • Is successful after standard trabeculectomy has failed
   • No removal of any sclera or iris tissue
   • Improve patient outcomes and visual recovery
   • High success rate at lowering intraocular pressure (IOP)
   • Fewer complications

In addition to all the above mentioned procedures, research is showing promising results for other under-development procedures too. These procedures give a hope for improved glaucoma management and may be improved vision too.