Stockton / Modesto Glaucoma Surgery Specialist – Dr. Ash
Serving Tracy, Merced, Manteca
Glaucoma surgeries are varied in type, but all have the mission of bringing the pressure under control. As discussed in other pages, the intraocular pressure is the single most important risk factors that we know how to control to avoid the progression of glaucoma and vision loss.
The glaucoma surgeries can be performed either via laser or true surgical instruments. Surgery is contemplated when the intraocular pressure is no longer "adequately controlled." The point of adequate control is one that has to be determined only by your ophthalmologist, and certainly not this website. In general the laser procedures tend to control the pressure very minimally (in the range of few point) for short time (few years). The true surgical procedures discussed here will be filtering procedures and implant procedures.
Trabeculectomy is the most common filtering procedure performed. This procedure removes a small segmental portion of the trabecular meshwork and creates an escape pathway for the fluid inside the eye. The fluid leaves through the small trabecular hole and tracks through the tissue and escapes to an area under the conjunctiva called "bleb." The conjunctiva is the outer skin of the eye and is loose and has the ability to slid around, much like the skin of a cat. The escaped fluid from inside the eye accumulates under the area adjacent next to the hole and causes the area to rise and form the bleb. The clinical appearance of the bleb is seen in the photograph on the right. This raised bubble of tissue can sometimes cause a slight discomfort such as foreign body sensation (like there is sand in the eye). Generally, this discomfort is short lived and dissipates.
Considerations: Trabeculectomies (commonly referred to as "trabs") are a serious surgery and should be weighed heavily. You ophthalmologist must have carefully assessed your situation and condition if such surgery was offered. Just like any surgery one must consider the risks, benefits, and alternatives. The surgery is generally very successful, but sometimes, it can fail and not achieve sufficient reduction in pressure. In that case either resumption of drops may be the option or another surgery may be contemplated. In some cases (surgeon dependent, but probably around 5% of surgeries), the trabs may work too well and drop the pressure too far down. When the pressures are less than 5mmHg, a deflationary problem can occur such as choroidal effusions, choroidal hemorrhages, and hypotony maculopathy which can cause significant permanent loss of vision.
Tubes are also an important surgical procedure for glaucoma. Typically tubes are considered in more advanced cases and circumstances. There are certain glaucoma types where tubes are a better option as trabs tend to have much less success. Tubes are just simply that... a plastic tube placed in the eye to drain fluid from inside the eye to outside the eyeball generally to an implanted reservoir. The clinical photo placed on the right shows image of a Ahmad tube performed by my excellent colleague Rick A. Lewis, MD of Sacramento, CA. Tubes must be properly placed with good length inside the eye (not too long, not too short) and must be in correct direction (not too close to the cornea and not too low next to iris. The Visante OCT images of an the Ahmad tube shown below highlight all the point made above. The yellowish material above the tube under the conjunctiva is a material called "tutoplast" that acts as a buffer to better position the tube and prevent its movement or erosion though the conjunctiva. It can be seen as the bright tissue on the visante overlying the tube as it egresses the anterior chamber.
Page last edited 08/23/09
Dr. Ash's advanced education and experience allow him to perform a variety of sophisticated surgical eye treatments, including glaucoma surgery, LASIK and cataract surgery. In fact, Dr. Ash is renowned as a leading Stockton / Modesto cataracts surgeon. He also enjoys a reputation as an exceptionally gifted LASIK Stockton / Modesto surgeon.
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