Glaucoma

Jaskra jest chorobą nieuleczalną, dlatego jej leczenie trwa do końca życia chorego. Terapia jaskry ma na celu wyłącznie zatrzymanie postępu choroby. Dlatego bardzo ważne jest, żeby wykryć jaskrę jak najwcześniej. Przy możliwie najwcześniejszym wykryciu jaskry istnieje mniejsze ryzyko poważnego uszkodzenia nerwu wzrokowego, co oczywiście przekłada się na naszą jakość widzenia.

Postęp choroby hamujemy obniżając ciśnienie śródgałkowe. Służą temu różne metody.

Zależy od stopnia postępu jaskry i jej postaci. Jeśli postępy choroby  są niewielkie, zaczynamy od leczenia farmakologicznego. W kolejnych etapach zalecane są zabiegi laserowe np. SLT. Przy bardziej zaawansowanych postaciach jaskry potrzebna jest operacja przeciwjaskrowa.  Stosuje się ją najczęściej w połączeniu z operacją zaćmy lub u pacjentów, którzy operację zaćmy przeszli wcześniej.

We should decide to undergo a glaucoma surgery when the affected eyes respond badly to pharmacological treatment, or when treatment with drops is impossible for various reasons. Glaucoma surgery can be combined with a planned cataract surgery (phacoemulsification).

There are several types – the ophthalmic surgeon will choose the most appropriate for the patient.

Trabeculectomy: surgery that aims to create an artificial fistula through which aqueous humor can escape from the anterior chamber.  The surgery is very effective, but unfortunately it is fraught with complications, including the development of cataract, which is why glaucoma is often operated together with cataracts.

Trabeculectomy with ExPress shunt: an improved version of trabeculectomy. During this surgery, the surgeon uses a very thin needle to place a microscopic shunt made of surgical steel in the eye. Unfortunately, because the procedure requires the use of a very precisely selected shunt, the cost of this surgery is higher than that of a traditional trabeculectomy.

Canaloplasty: the new, minimally invasive method of treating glaucoma. During the procedure, the surgeon unclogs existing pathways for aqueous humor outflow by inserting a non-absorbable prolene suture into Schlemm’s canal and tightening its walls.

Laser iridectomy: a minimal hole is made in the iris with a very precise laser, in order to improve humor exchange between the anterior and posterior chamber. Very often this procedure effectively stops the progress of glaucoma.

However, it should be remembered that the eye after this a procedure should be regularly checked by a specialist – the hole is so small that it sometimes overgrows and the procedure should be repeated.

Surgical iridectomy: very similar in the procedure and effects to the laser iridectomy, but performed surgically. It is opted for when there are contraindications to laser surgery.

Cyclocryotherapy: using low temperatures on the ciliary body (the part of the eye that surrounds the retina). It is used in patients with advanced glaucoma experiencing pain and very elevated intraocular pressure. If the cryotherapy treatment is repeated within 3-6 months, the pressure may begin to remain stable, but the patient must remain under regular supervision.

Endoscopic cyclophotocoagulation: a modern method of reducing the production of aqueous humor. It involves using laser to treat the ciliary processes that produce the aqueous humor.

• on the day of the surgery, you should report to the Clinic wearing comfortable clothes (e,g. a tracksuit); you will be given a disposable patient bodysuit
• on the day of the surgery do not put on facial or eye makeup,
• prescribed chronic-use medications should be taken at the usual time, except the ones listed below,
• 3-7 days before the surgery patients should discontinue blood thinners, such as: Acard, Aspiryna, Aspro C, Asprocol, Polopiryna, Rhonal, Ring N, Solucytel, Thomapyrin, Pradaxa, Xarelto, Plavix, Warfin, Acenokumarol.

Prior to the scheduled surgery you will be provided with additional detailed information.

The patient stays at our Centre for about 3 – 4 hours.

Obviously the surgery itself takes less time. It is performed under the so-called combined anesthesia. This means cooperation between an anesthesiologist, who administers intravenous sedatives and painkillers, and an ophthalmologist, who administers local anesthesia to the eye.

• After the procedure the patient should not use public transport, and should be escorted home by an adult companion.
• For 24 hours after anesthesia the patient cannot drive, operate dangerous equipment or drink alcohol.
• After the surgery the face should not be immersed in water and the eye should be kept dry, as this can lead to infection. For 3 weeks caution should be exercised when bathing, until the wound becomes watertight.
• For 2-3 weeks after the surgery patients should abstain from doing work that requires a lot of physical effort (e,g., moving heavy furniture or lifting over 15 kilograms).
• On sunny days patients should wear sunglasses.
• The dressing remains on the patient’s eye until the first follow-up visit, which takes place the day after the procedure. Then next follow-up visits are scheduled. Ophthalmic drops should be used according to the regime specified in the treatment information sheet.