In some cases, the intraocular pressure of the eye can not be controlled by the basic methods. Your ophthalmologist may suggest glaucoma surgery or more advanced treatments to meet your needs. You will find below all the procedures practiced at the Bellevue Clinic in the treatment of glaucoma.
Canaloplasty is a surgical procedure used in the treatment of glaucoma. In this non-penetrating surgery, a suture is spun along the inner drainage channel of the eye (Schlemm's canal) using a fiber optic microcatheter. The yarn is then knotted with a little tension to dilate the canal again, thus restoring the natural flow of the aqueous humor.
To open the 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 channel with a flashing light at the end. Once the line is complete, the suture is threaded and tied. This technique dilates and rectifies the Schlemm's canal and trabeculum pathways, and thus restores the evacuation of the aqueous humor and lowers the IOP.
The purpose of trabeculectomy is to create a passage from the anterior chamber of the eye to the outside of the eye to evacuate the aqueous humor. At the beginning of the procedure, 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 drilled to the anterior chamber. However, the aqueous humor can evacuate from the anterior chamber and pass through the scleral flap, and go under the conjunctiva where it will be resorbed 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 obstruct the tunnel. The scleral flap is then closed with stitches to prevent the IOP from descending to zero at the end of the operation (before scarring is formed). Finally the conjunctiva is closed with stitches, so that a liquid bubble can form there, acting as a filter. This filtering bubble is normally found on the upper part of the eye and is covered by the eyelid. The fluid that accumulates is slowly absorbed by the blood vessels of the sclera and conjunctiva.
The iStent is one of the smallest implants available for glaucoma surgery, it mesures 1.0 mm by 0.5 mm. This device has the shape of a miniature snorkel. One end is inserted into the anterior chamber and the other end into the Schlemm's canal, allowing the aqueous humor to bypass the obstructed trabeculum lanes. The iStent is implanted through a corneal incision measuring 1.7 mm, and usually, no suture is required. It is held in place by three protrusions located on the part inserted in the Schlemm's canal.
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 generally used for patients with uncontrolled glaucoma or primary open-angle glaucoma.
Hydrus is a micro-stent made of an alloy of nickel and titanium without any allergens. It is inserted into the main drainage channel of the eye to reduce intraocular pressure. It can also reduce the need for eye drops medication.
This procedure is best for patients with mild to moderate open-angle glaucoma.
The GATT procedure (transluminal trabeculectomy assisted by gonioscopy) is used in cases of advanced glaucoma. This is a minimally invasive surgery and a variant of trabeculectomy. The operation is performed via micro-incisions in the cornea through which the intervention is completed. After entering the eye, the surgical procedure consists of piercing the trabecular meshwork, cannulating the Schlemm canal 360 ° and unroofing it.
One of the advantages of this intervention is that it does not involve the opening of conjunctival tissues to access Schlemm's canal. Thus, the patient will have fewer scars and, if necessary, subsequent surgeries will have higher success rates.
The procedure of the trabectome surgery uses a heating instrument and a slight suction to remove a portion of the trabeculum. The trabectome is inserted through the cornea, the trabeculum and into the Schlemm's canal, and then guided along the trabecular meshwork. This procedure facilitates the evacuation of aqueous humor by increasing access to evacuation routes
Deep sclerectomy is a variant of trabeculectomy. Instead of perforating the sclera to the anterior chamber, the surgeon leaves a thin layer of sclera. This allows the aqueous humor to escape through the sclera layer as 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 low pressure drops and intraocular bleeding which restores visual function quickly. The disadvantage, however, is that sometimes the IOP is not reduced enough.
DR PAUL HARASYMOWYCZ
Medical Director of the Bellevue Ophthalmology Clinics and the Montreal Glaucoma Institute
Founder and Medical Director of the Bellevue Ophthalmology Clinics and the Montreal Glaucoma Institute, and Associate Professor at the University of Montreal, Dr. Harasymowycz works as a clinician and researcher at The CUO (Centre Universitaire d’Ophtalmologie) and the Guy-Bernier Research Center since 2001. He was Chief of Glaucoma at University of Montreal for over 15 years and is a Faculty Member of the International Congress of Glaucoma Surgery. He is also Medical Director of the Quebec Glaucoma Foundation, created in 2007 in order to promote research on glaucoma and to raise awareness of the disease including early screening of patients at high risk.
Dr. Harasymowycz is a glaucoma committee member of the ASCRS and International Judge of XOVA Excellence in Ophthalmology Vision Award. He focuses his research on glaucoma screening, new diagnostic and ocular imaging technologies, as well as on new surgical treatments for glaucoma and cataract surgery. Moreover, he is often sought out to present and teach new surgical techniques and treatments at national and international congresses, and is recognized as an innovator in MIGS techniques.
Dr. Harasymowycz enjoys research and over the last 20 years has published over 70 articles in various national and international scientific journals, as well as book chapters. Passionate, he teaches to students, residents, fellows, and other health care professionals.
THE ADVANTAGES OF SURGERY AT BELLEVUE CLINIC
The Bellevue 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.