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  (65) 6738 2000
Glaucoma Surgery
Laser treatment or surgery is offered to patients whose disease condition has not been well-controlled with medications or who suffer adverse reactions to medications.

What Kinds of Laser Surgery Are Performed For Glaucoma?

Laser surgeries lower intraocular pressure by enhancing the drainage of aqueous fluid or slowing its production. In angle closure glaucoma, a laser peripheral iridotomy is performed to widen the drainage angles and improve aqueous flow from behind the iris to the front of the eye.

In some open angle glaucomas, selective laser trabeculoplasty can help reduce eye pressure. This improves aqueous drainage by clearing the microscopic debris in the drainage angles. Patients may still need to continue their glaucoma eyedrops to control the eye pressure after the laser treatment and sometimes a repeat laser procedure is required.

Some patients require laser cyclophotocoagulation which destroys the cells in the eye that produces the fluid in the eye, thereby lowering the eye pressure. This is performed as a day surgery procedure under local anaesthetic with sedation. This is especially useful if the eye pressure is very high despite maximum medications and it is not suitable to perform other forms of surgery.

What Types Of Surgery Are Performed For Glaucoma?

Trabeculectomy is performed as a day surgery procedure, under local anaesthetic with sedation to help a patient feel more comfortable. It can be performed alone or in combination with cataract surgery. A small opening is created in the wall of the eye allowing fluid from inside the eye to flow out and be contained in a bubble under the eyelid. This will lower the eye pressure and protect the optic nerve from damage. The normal scarring and healing response of the body can cause the surgery to fail because the egress of fluid from the inside of the eye is obstructed. A special medicine, mitomycin C, is applied at the time of surgery to try to prevent this. The patient continues to use antibiotic and steroid eyedrops for a few months after surgery but often does not need to use their glaucoma eyedrops.

Glaucoma tube implant surgery is performed if trabeculectomy surgery is likely to fail, for example if vigorous scarring is expected after surgery or if the eye has previously undergone surgeries. This is also done as a day surgery procedure under local anaesthesia with sedation. It can also be done alone or in combination with cataract surgery. A small silicone implant is stitched to the wall of the eye with tube entering the front of the eye. This allows fluid from inside to drain out and be contained in a bubble under the eyelid.

The iStent Trabecular Micro-Bypass Stent is a new surgical option in the treatment of glaucoma. It is a form of Minimally Invasive Glaucoma Surgery (MIGS). Measuring 1mm in length, it is the smallest medical device used in humans.

What Does the iStent Do?

The iStent creates a permanent opening that bypasses the blockage in the drainage system to improve the eye’s natural fluid outflow. This reduces the eye pressure to prevent damage to the nerve at the back of the eye, thus preventing blindness.

Is it Effective in Lowering Eye Pressure? Is it Safe to Use?

This implant is approved by the US Food & Drug Administration (FDA) and the Health Sciences Authority (HSA) in Singapore. More than 1million iStents have been used in glaucoma patients in USA and Europe with good results in lowering eye fluid pressure and it has an excellent safety profile.

Clinical studies have shown that patients who received the iStent implant experienced between 16-40% (4 – 10mmHg) reduction in eye fluid pressure. These patients also had a substantial reduction in the number of glaucoma eyedrops they required, with some of them not needing eyedrops anymore. In addition, the complications arising from iStent in conjunction with cataract surgery were similar in number and severity to cataract surgery alone.

Who Should Undergo the Surgery?

The iStent  is indicated in patients with Open Angle Glaucoma  and can be implanted at the same time that a person is undergoing cataract surgery. It can also be used in those who previously had cataract surgery. While conventional forms of glaucoma surgery are suitable for patients with advanced glaucoma, the iStent implant can be used in those with mild and moderate glaucoma with:

  1. Eye pressure inadequately controlled with eyedrops and/ or laser treatment
  2. Adverse/ allergic  reactions to eyedrops

Being minimally invasive, the advantages of iStent surgery over conventional glaucoma surgery are:

  1. Fewer complications
  2. Shorter recovery time
  3. Greater patient comfort
  4. Conventional glaucoma surgery can still be performed in future if needed

After glaucoma surgery, patients should return for regular check up visits so they can receive appropriate and timely treatment for complications that arise.

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Glaucoma Surgery
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