The Glaucoma



The glaucoma therapeutic options, in addition to the medicinal therapy by drugs, are para-surgical and surgical.



SUBJECTS:


Para-surgical Therapy


When we discuss about para-surgical therapy, we mean a laser therapy . The use of Laser ray for glaucoma is intended to modify the ocular outflow system in order to obtain an easier aqueous humor outlet from the eye. Proceedings and kinds of laser rays are different according to the kind of glaucoma and to the extent of its development.




What Is a Laser?


The laser is a uniform and powerful ray of light that can be produced through different ways. Different kinds of laser are used for the ophtalmological field in order to exploit the characteristics of each ray. The effect of laser irradiation on the target can be evaporation, lancing or heating.



Two kinds of laser rays are used: an "hot" laser the ARGON LASER and a "cold" one, the YAG-LASER. The definitions of "hot" and "cold" describe the effect of this laser on the tissues concerned.


What Is ARGON Laser?


The Argon laser is utilized for its irradiation thermal action (for this reason it is called HOT laser). This action can be exploited for its healing effect on the tissues concerned.



What Is YAG Laser?


The Yag laser is utilized for its capability of producing micro lancing (for this reason it is called COLD laser). This action can be exploited for its drilling effect on the tissues concerned.

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TRABECULAR PLASTIC


This surgical method, also defined ARGON-LASER TRABECULAR PLASTIC (ALT), is adopted for the chronic glaucoma belonging to the "wide angle" category and produces an enlargement of the trabecular outlet system through the laser thermal action, thus helping the aqueous humor outflow and consequent reduction of the ocular pressure.


Possible Results


A reduction of the ocular pressure is obtained for the 70/80% of the cases treated by this surgical method. The size of this reduction is depending on several factors, therefore it is impossible to foresee neither the final result, nor if this will be sufficient for preventing further damages caused by the glaucoma.



Sometimes the pressure reduction due to the use of laser is only temporary. However for the successfully treated cases, this method allows to postpone for a lot of time the surgical operation through an absolutely bloodless technique. In the same way it can allow the reduction, when not the removal, of the pharmacological therapies, even if for most of patients a constant utilization of anti-glaucoma collyrium is needed.


The trabecular plastic is usually adopted when the medical therapy is no longer sufficient to produce a therapeutic compensation and we want to postpone a surgical operation (i.e. for instance in the younger patients).


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IRIDESTOMIA


This surgical method is adopted for the glaucoma belonging to the "narrow angle" category. It is performed by drilling a small hole inside iris thus connecting the fore room and the back room and helping the aqueous humor outflow from the second room to the first one. This “tiny window” helps the ocular fluid circulation towards the outlet vessels and prevents the sudden lock of the outflow angle.




The iridestomia is adopted for the glaucoma belonging to the "acute" category in order to remove the angle obstruction, significantly reducing the sharp pain which characterizes this kind of glaucoma, and for prophylactic purposes in the patients exposed to the risk of an acute attack. In fact it is practiced on the other eye of the persons who have had an acute glaucoma attack on one eye.

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How Does Treatment Occur?


Both techniques are performed by laying an adequate contact lens on the patient’s eye thus allowing focusing the laser ray, after dropping some anhestetic collyrium and a special protection gel.


Generally this operation is painless and it lasts only a few minutes, causing the patient a sense of dazzling at the end of treatment, like if he had been subjected to a camera flash.

Both methods are ambulatory performed at our surgical center Fata Morgana


For learning more about the glaucoma physiopathology, please visit our Section "THE EYE AND ITS PATHOLOGIES".

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