Glaucoma Surgeries & Treatments

In some cases, intraocular pressure (IOP) cannot be controlled by basic methods. Therefore, your ophthalmologist may suggest glaucoma surgery or a more advanced treatment tailored to your needs. Below, you will find all the procedures performed at Bellevue Ophthalmology Clinic as part of glaucoma treatment.

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Discover the Various Treatment Methods for Glaucoma

Canaloplasty

Canaloplasty is a surgical procedure used in the treatment of glaucoma. In this non-penetrating surgery, a suture is inserted along the internal drainage canal of the eye (Schlemm's canal) using a microcatheter made of optical fibers. The thread is then tied with slight tension to once again dilate the canal, thereby restoring the natural flow of aqueous humor.

To open Schlemm's canal, a viscoelastic polymer is injected and is absorbed within a few days. Then, the end of the microcatheter is inserted and navigated along the canal with a flashing light at the end. Once the line is complete, the suture is threaded and tied. This technique dilates and corrects the pathways of Schlemm's canal and the trabeculum, thus restoring the drainage of aqueous humor and reducing intraocular pressure (IOP).

Xen Gel Implant

The Xen Gel implant is a 6mm hydrophilic tube. It decreases intraocular pressure by creating a permanent drainage shunt between the anterior chamber of the eye and the subconjunctival space.

It is typically used for patients with uncontrolled glaucoma or primary open-angle glaucoma.

Trabectome

The trabectome procedure employs a heated instrument and gentle suction to remove a portion of the trabeculum. The trabectome is inserted through the cornea, the trabeculum, and into Schlemm's canal, and then guided along the trabeculum. This procedure facilitates the drainage of aqueous humor by increasing access to the outflow pathways.

Trabeculectomy

The aim of trabeculectomy is to create a passage from the anterior chamber of the eye to the outside of the eye to drain aqueous humor. Firstly, an incision is made through the conjunctiva. Then, the surgeon creates a flap in the sclera (the wall of the eye). Below the scleral flap, a hole is made leading to the anterior chamber. Thus, aqueous humor can drain from the anterior chamber and pass through the scleral flap to reach beneath the conjunctiva where it will be absorbed by blood vessels.

The iris is grasped through the tunnel, and a small piece is excised with scissors (iridectomy) to ensure that the iris does not block the tunnel. The scleral flap is then closed with sutures to prevent the intraocular pressure (IOP) from dropping to zero at the end of the operation (before healing occurs). Finally, the conjunctiva is closed with sutures to allow a fluid bubble to form, acting as a filter. This filtering bubble is usually located on the upper part of the eye and is covered by the eyelid. The fluid that accumulates there is slowly absorbed by the blood vessels of the sclera and conjunctiva.

Hydrus

The Hydrus is a micro-stent made of a nickel and titanium alloy without allergens. It is inserted into the main drainage canal of the eye to reduce intraocular pressure. It can also reduce the need for eye drop medication.

This procedure is best suited for patients with mild to moderate open-angle glaucoma.

Deep Sclerectomy

Deep sclerectomy is a variation of trabeculectomy. Instead of perforating the sclera all the way to the anterior chamber, the surgeon leaves a thin layer of sclera. This allows aqueous humor to escape through the scleral layer like through a coffee filter. Some surgeons insert a micro-collagen implant into this scleral space to prevent tissue scarring. The advantage of this operation is that it avoids excessively low pressure drops as well as intraocular bleeding, which restores visual function more quickly in the patient. The disadvantage is that sometimes, the IOP is not reduced enough.

iSTENT

The iStent is one of the smallest implants available for glaucoma surgery, measuring 1.0 mm by 0.5 mm. This device resembles a miniature snorkel, with one end protruding into the anterior chamber and the other end inserted into Schlemm's canal, allowing aqueous humor to bypass the obstructed trabecular pathways. The iStent is implanted through a corneal incision measuring 1.7 mm, and often, no sutures are required. It is held in place by three protrusions located on the part inserted into Schlemm's canal.

GATT

The GATT procedure (Gonioscopy-assisted Transluminal Trabeculotomy) is used in cases of more advanced glaucoma. It is a minimally invasive surgery and a variant of trabeculectomy. The operation is performed through micro-incisions in the cornea through which the intervention is completed.

After entering the eye, the surgical procedure involves piercing the trabeculum, cannulating Schlemm's canal 360°, and clearing it. One of the advantages of this intervention is that it does not involve opening conjunctival tissues to access Schlemm's canal. Thus, the patient will have fewer scars, and if needed, subsequent surgeries will have higher success rates.

The Advantages of Surgery At Bellevue Ophthalmology Clinic

Minimal waiting time

A guaranteed operation date

A personalized, efficient and safe postoperative care

Procedures

Preoperative evaluation

Preoperative preparation

Surgery

Postoperative follow-up

The Bellevue ophthalmology clinic provides state-of-the-art glaucoma surgery services to its patients. Our modern facilities, cutting-edge equipment and experienced staff ensure effective, professional and personalized care.

*We also operate patients NON-RESIDENTS of Canada.