Glaucoma Services

It is normally associated with increased fluid pressure in the eye. The term “ocular hypertension” is used for people with consistently raised intraocular pressure (IOP) without any associated optic nerve damage. Conversely, the term ‘normal tension’ or ‘low tension’ glaucoma is used for those with optic nerve damage and associated visual field loss, but normal or low IOP.

Raised intraocular pressure (above 21 mmHg) is the most important and only modifiable risk factor for glaucoma. Untreated glaucoma can lead to permanent damage of the optic nerve and resultant visual field loss, which over time can progress to blindness.

Glaucoma can be roughly divided into two main categories, open & closed angle respectively.

Closed-angle glaucoma can appear suddenly and is often painful and visual loss can progress quickly, but the discomfort often leads patients to seek medical attention before permanent damage occurs.

Open-angle, chronic glaucoma tends to progress at a slower rate and patients may not notice they have lost vision until the disease has progressed significantly. Glaucoma has been called the “silent thief of sight” because the loss of vision often occurs gradually over a long period of time, and symptoms only occur when the disease is quite advanced.

The modern goals of glaucoma management are to avoid glaucomatous damage and nerve damage, and preserve visual field and total quality of life for patients, with minimal side effects. Intraocular pressure can be lowered with medications, usually eye drops. Several different classes of medications are used to treat glaucoma, with several different medications in each class.

Both laser and conventional surgeries are performed to treat glaucoma.

Argon laser trabeculoplasty (ALT) may be used to treat open-angle glaucoma. It is a temporary solution, not a cure. A newer type of laser trabeculoplasty uses a “cold” (non-thermal) laser to stimulate drainage in the trabecular meshwork. This newer procedure called selective laser trabeculoplasty (SLT), selectively targets melanin pigment in the trabecular meshwork cells. SLT may be repeated three to four times.

Laser peripheral iridotomy (LPI) may be used in patients susceptible to or affected by closed angle.

The most common conventional surgery performed for glaucoma is the trabeculectomy. Sometimes this surgery combined with use of chemotherapeutic agents, most commonly Mitomycin C (MMC, 0.5-0.2 mg/ml) or 5 Florouracil (5-FU, 50 mg/ml), are used locally on the surgical site as indicated. Glaucoma patients not responding to maximal medical therapy, with previous failed guarded filtering surgery (trabeculectomy) often can be treated with glaucoma drainage implant shunt surgeries. In indicated cases, laser therapy to reduce the eye pressure is also used called “Transscleral Cyclophotocoagulation” using 810 nm diode laser.

Ahmed Valve glaucoma surgery is performed in difficult glaucoma surgery with great success.