Glaucoma Treatment & Surgery
SLT | Trabeculectomy | Ahmed Valve | ECP | Deep Sclerectomy
Selective Laser Trabeculoplasty (SLT)
SLT is a treatment for glaucoma which is an improvement upon the previous method, called ALT. It involves a specialized laser that treats the drainage mechanism inside the eye by opening up channels which allow the fluid to drain out of the eye at an increased rate. This in turn causes the pressure inside the eye to decrease.
A special lens is applied to the eye during the procedure. The procedure takes approximately 5 minutes per eye and is an outpatient procedure. It is relatively painless and there is no restrictions afterwards.
Here the laser is shown treating the drainage area called the trabecular meshwork
Trabeculectomy
A trabeculectomy is a type of surgical procedure in which a drainage canal is created in the eye and the fluid is allowed to drain under the covering of the eye called the conjunctiva. It is a very effective surgery for many types of glaucoma.
Above is shown a diagram of the trabeculectomy procedure. It shows the drainage canal being created in the wall of the eye. The fluid is allowed to filter through and is reabsorbed by the body, thus lowering the pressure in the eye.
This diagram shows the direction of flow through the surgery site.
Ahmed Valve Surgery
The Ahmed valve is a type of implantable device known as a glaucoma drainage device which is implanted onto the eye to drain the aqueous humor out of the eye. It is very useful in certain types of glaucoma whereas other surgery types may fail.
This is a picture of the Ahmed valve.
Above is shown the Ahmed valve in place on top of the eye. It is covered by the conjunctival layer of the eye and is not visible after implantation.
Endocyclophotocoagulation (ECP)
ECP is a procedure which uses a laser probe with a camera to shrink the tissue inside of the eye that produces the fluid of the eye. This in turn causes production of less fluid and decreases the pressure inside of the eye.
The machine is shown above, made by EndoOptiks. The microprobe is attached.
The probe, shown here, is transmitted through the pupil at the time of surgery and the laser beam shrinks the ciliary processes, which produce the fluid in the eye.
This is an image seen by the surgeon through the endoscopic camera during surgery.
ECP is a great procedure, especially when performed in conjunction with cataract surgery. Patients with glaucoma and cataracts can now have ECP to attempt to stop one or more glaucoma drops. In the past, other glaucoma procedures done at the time of cataract surgery have been wrought with complications. ECP has a very low complication rate and is extremely effective, often lowering the pressure significantly.
Deep Sclerectomy with Aquaflow
Deep sclerectomy is a variation of the trabeculectomy surgery. It is not a full-thickness procedure, meaning that the drainage canal is not tunnelled all of the way through the wall of the eye. Instead, the drainage canal in the wall of the eye, known as the Canal of Schlemm, is accessed and opened, thereby increasing the flow of the fluid in the eye.
The steps of the deep sclerectomy and Aquaflow placement are shown above. This procedure does not have as high a complication rate as other surgeries. However, the pressure lowering-effect is not as great. Still, it is a very good option for those who want to eliminate drops or who do not tolerate drops well.
