The Future of Glaucoma Surgery
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The advanced technology and new surgical techniques discussed in this article appear promising as new surgical approaches; however, they are still being evaluated by glaucoma treatment professionals.
As with any new surgical methods, there is little or no long-term follow-up to determine safety and efficacy as compared to existing, proven surgical treatments for glaucoma. Talk to your doctor if you are interested in learning if one of these surgical approaches might be effective in treating your glaucoma.
New Surgical Approaches
Micropulse Laser Trabeculoplasty (MLT)
Micropulse laser trabeculoplasty (MLT) promises to provide the same pressure-lowering effects as argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) with less energy and inflammation than the other procedures. MLT uses a specific diode laser (IQ 810, Iridex) with a much longer pulse length than SLT, but the temperature rises slowly, because laser energy is delivered in short microbursts over an extended period of time (milliseconds versus nanoseconds for SLT). The micropulse helps to minimize the spikes in eye pressure that can sometimes occur after a laser procedure.
In this procedure, first the doctor makes a small incision in the eye. Then the Canaloplasty microcatheter is inserted into the eye's drainage system canal. The doctor then uses the microcatheter to circle the canal and enlarge it to help the aqueous fluid to drain. Then the microcatheter is removed and a suture is placed within the canal to keep it open. The idea is to restore the eye's drainage system to lower the pressure in the eye. The Canaloplasty microcatheter, which treats open-angle glaucoma, was granted FDA clearance in September 2008.
Trabectome® is a minimally invasive procedure designed to improve fluid drainage from the eye to balance intraocular pressure in patients with open-angle glaucoma. The surgery is performed through a small incision and does not require leaving a permanent hole in the eye wall or creation of an external filtering bleb (fluid collection on the outside of the eye) or an implant. The pulse from an electrosurgical handpiece is used to open access to the eye's drainage system. Trabectome is an out-patient surgery that allows the patient to go home the same day. The Trabectome was FDA cleared in 2004.
The Ex-Press Mini Shunt
The Ex-Press Mini Shunt is a very small stainless steel device used to augment conventional trabeculectomy surgery. The device helps to standardize the operation and may also reduce the chances of the eye pressure getting too low in the immediate post-operative period. The Ex-Press Mini Shunt allows precise control of the amount of fluid allowed to flow out of the eye, which helps to maintain a healthy level of internal pressure. It is sometimes used after a standard trabeculectomy has failed, to increase the chances of a successful outcome. This device has been in use since 2002.
Last reviewed on July 19, 2012