Glaucoma Surgeries & Treatments
When medical treatments are no longer sufficient to control eye pressure, glaucoma surgery may be considered. Bellevue offers various surgical techniques, such as trabeculectomy, canaloplasty, or shunt implantation. Our experienced team will guide you throughout the process to help you choose the best solution for your specific case.
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.
PRESERFLO MicroShunt
The PRESERFLO MicroShunt is a small surgical implant used to treat glaucoma. It allows the aqueous humor to flow from the anterior chamber to the subconjunctival space. By reducing the excess fluid within the eye, it lowers the intraocular pressure. This helps to protect the optic nerve and prevent vision loss.
Micropulse Laser
Micropulse laser is a modern and precise technique used to treat glaucoma. It works by emitting short pulses of light that reduce the pressure inside the eye, the main factor in glaucoma. This method is less invasive than traditional surgeries, reducing the risk of complications and increasing patient tolerance. It also helps slow the progression of the disease and preserve vision.
Ahmed & Baerveldt Tubes
These tubes are surgical implants used to treat glaucoma. The Ahmed tube is equipped with a valve that regulates the flow of aqueous humor. This valve adapts to pressure variations, reducing the risk of excessively low pressure in the eye. The Baerveldt tube, on the other hand, is wider and does not have an integrated valve. This allows for greater drainage.
These implants are generally considered when medical treatments are no longer sufficient to control eye pressure.
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.
Trabeculotomy
Trabeculotomy is a less invasive procedure than trabeculectomy. It involves creating a small opening in the trabecular meshwork to facilitate the outflow of aqueous humor. However, it is less effective than trabeculectomy in cases of advanced glaucoma.
It is often proposed as a first-line intervention, especially for early-stage glaucoma.
Hydrus
The Hydrus is a micro-stent made of a non-allergenic nickel-titanium alloy. It is inserted into the eye's main drainage canal to reduce intraocular pressure by increasing the outflow of aqueous humor through natural pathways.
It can also reduce the need for eye drop medication.
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 trabeculotomy. 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.
Cyclophotocoagulation (CPC)
Cyclophotocoagulation is a medical procedure used to treat glaucoma. It involves using a laser to target and destroy a part of the eye called the ciliary body. This part, located behind the iris, plays a crucial role in the production of aqueous humor.
It is often used as a last resort treatment for refractory glaucoma, meaning glaucoma that does not respond to traditional medical treatments (eye drops) or surgery.
iTrack Advance
The iTrack Advance is a canaloplasty microcatheter used to treat open-angle glaucoma by performing pressurized viscodilation and 360-degree catheterization of the conventional outflow pathway. It features an ergonomic and easy-to-use injector that allows for simple insertion of the microcatheter into Schlemm's canal.
The Advantages of Surgery At Bellevue Ophthalmology Clinic
Procedures
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.