Eye pressure is determined by a balance between the production and removal of pre-chamber fluid. When an imbalance occurs, it can lead to an increase in eye pressure with secondary risk of irreparable damage to the optic nerve. At this stage we speak of glaucoma. There are different forms of glaucoma: open angle versus closed angle, acute versus chronic form.
Failure to treat this condition can lead to scotoma or blind spots, initially in the peripheral, field of vision, and later even blindness. Given the slow and creeping course of the disease, screening from the age of 40 is recommended. In case of a family history, an earlier screening is recommended.
The aim of the treatment is to lower the eye pressure, under a target pressure, which is determined individually, in order to prevent further damage.
These eye drops can exert their effect in two ways: on the one hand, by increasing the discharge of the anterior chamber moisture or, on the other hand, by reducing the production of anterior chamber moisture. Eye drops can be found in many different strengths and combinations.
Argon Laser Trabeculoplastie
The aim of this laser treatment with argon laser is to facilitate the drainage of the pre-chamber fluid by stretching the drains somewhat open using laser coagulates. Patients who qualify for this treatment must have an open front chamber angle. This treatment takes place during a consultation and is virtually painless.
Yag Laser Iridotomy
With closed chamber angle glaucoma, the outlet of the pre-chamber moisture is closed off. When this occurs acutely, there is suddenly a sharp rise in pressure with even the risk of blindness if not treated quickly. With the Yag laser a small hole is then made in the iris which creates space again and facilitates the discharge, resulting in a drop in pressure. Here too, the treatment is virtually painless and takes place at the consultation.
When drops and/or laser have insufficient effect, filtering surgery is recommended. The aim of the technique is to increase the discharge of the anterior chamber fluid.
These operations do not aim to improve vision, on the contrary – initially vision is even a little blurred due to low eye pressure – but the primary goal is to stabilize the current situation and prevent further progression.
Xen Gel Implant
With this technique, a small tube consisting of pig collagen, 6 mm long and as thin as a human hair is placed in the anterior chamber angle, using two small incisions in the cornea so that the anterior chamber fluid can leave the eye in a filtration bladder. This technique is less invasive and more tissue-saving than classical trabeculectomy.
Here too, the stent may grow closed and a second (smaller) intervention may be advisable. The operation is performed under local (retrobulbary) anaesthesia in the operating room, in a day hospital.
During this procedure, a canal is made of the own tissues (namely the conjunctiva) and the pre-chamber fluid runs into a filtration vesicle under the upper eyelid. In order to adjust the canal, a small flap is made with sutures on it, which can be released post-operatively, if necessary, with the laser.
It may be that the drain closes due to scar tissue, this must then be reopened by a second (smaller) procedure.
The procedure is usually performed under local (retrobulbar) anaesthesia in the operating room, in the day hospital.
Diode Laser Cyclodestruction
This treatment is used with patients with refractory or neovascular glaucoma. The ray body, the organ that produces the anterior chamber fluid, is partially destroyed so that the fluid production decreases and a pressure drop occurs. This treatment takes place in a day hospital under local (retrobulbary) anaesthesia and takes only a few minutes.