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What does the treatment involve?

Glaucoma filtration surgery (trabeculectomyy or non‐penetrating deep sclerectomy) or valve device implantation aims to encourage drainage of the aqueous humour and, therefore, control intraocular pressure by stabilising it for 24 hours and preventing fluctuations.

We call them filtration techniques because exactly what they do is help "filtrate" the intraocular liquid (aqueous humour) as it starts to flow out the eye, creating new ways to drain it.

When is this treatment indicated?

A decision is usually made to resort to filtration surgery when the patient no longer responds to to hypotensive eyedrops or is intolerant to them. 

Surgery is often chosen as the form of treatment as the glaucoma disease is found to be at very advanced stage in which surgery can provide more stable control of tension, preventing hypertensive peaks (without fluctuations).

Another case would be not being able to use laser surgery procedures or them not being sufficient. 

How is it performed?

Mediante la cirugía filtrante (trabeculectomía, o bien esclerectomía profunda no perforante), o bien a través de la implantación de dispositivos valvulares, se pretende favorecer el drenaje del humor acuoso y, por tanto, controlar la presión intraocular.

La técnica quirúrgica más comúnmente aplicada es la trabeculectomía. Se trata de una cirugía llamada filtrante, porque lo que intenta es crear un drenaje o fístula que permita la salida del líquido intraocular o humor acuoso sin obstáculos hacia el espacio subconjuntival.

Existe también otra técnica filtrante alternativa a la trabeculectomía llamada esclerectomía profunda no perforante.

Como diferencia más destacable entre ambas, es que en esta última no se hace una apertura completa de la fístula creada y, al no “abrir” del todo evitamos descompresiones bruscas; sin embargo suele requerir la apertura posterior mediante láser en alrededor de un 20–40% de los casos, que suele realizarse bajo anestesia tópica y ambulatoriamente. Además, para mantener el drenaje abierto se suele emplear un implante (o material estéril de diferentes composiciones).

Otra técnica quirúrgica para el abordaje del glaucoma serían los dispositivos de drenaje valvular, reservados para casos en los que se desaconsejan o no pueden aplicarse las anteriores técnicas. Todas ellas requieren realizarse en quirófano en condiciones de asepsia.

Cabe mencionar que en la mayoría de técnicas filtrantes para el tratamiento del glaucoma se emplean sustancias anticicatrizantes que intentan evitar la fibrosis y posterior cierre de la fístula creada. Las más empleadas son la Mitomicina-C y el 5-Fluoracilo

Results

The desired result of these surgical techniques is to get the patient's intraocular pressure under control, making it stable all 24 hours of the day and preventing fluctuations, which thereby contributes to controlling the glaucoma disease and stopping it from advancing. 

Furthermore, a large percentage of patients can go without hypotensive drop treatment after surgery, which increases their quality of life. 

Getting these results depends on the type of glaucoma the patient has, the previous anatomical state of the eyeball and the surgical technique used. Not all techniques are equally efficacious, although as in general medicine, none can offer a 100% guarantee of success.

Possible risks

When we talk about glaucoma surgery, the main risk associated with it is that it involves long-term loss of efficacy. The scarring (the body's power to close wounds) is the main enemy of filtration surgery. This is why the majority of techniques used anti-scarring substances to try to reverse the potential any healthy body has to do this. 

Other risks associated with glaucoma surgery are hypotonia due to overfiltration, the appearance of pores in the surgical wound that require additional sutures or haemorrhages. 

The most significant yet infrequent risks are infections and profuse bleeding. 

Professionals who perform this treatment

Frequently asked questions

  • After surgery, the eye is usually red or inflamed for a few days or weeks. Thus, patients must use anti-inflammatory and antibiotic drops for some time to avoid infections and counteract the inflammation. 

    It's most common that for the first few weeks after the procedure, the patient has blurred vision and notices discomfort, which are associated with the fistula created or the sutures in it. 

    Like in the majority of eye surgeries, the patient should stop practicing intense physical activities for the first few weeks and we advise taking life easy and not exerting oneself for the best post operative period. Time off work depends on the job the patient does.

  • Glaucoma is a group of diseases, which is why treatment has to be individualised depending on the type of glaucoma the patient has and the stage of the disease. 

  • Glaucoma is a chronic disease that requires ongoing check-ups and taking treatment seriously is essential for efficient control of the disease. As it is a symptomatic disease in its initial stages, early diagnosis is the best ally for controlling its evolution. 

    Primary glaucomas have a genetic base, which may—or may not—manifest themselves. Thus, an exhaustive review of the children of parents with glaucoma is recommended. In addition, those patients with predisposing factors should have annual eye check-ups.