Glaucoma - Medications

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Supportive Medication for Preventing Scarring. Specific drugs, usually mitomycin C, are often used along with the procedure to prevent scarring and closure.

Laser Trabeculoplasty

The Procedure. Laser trabeculoplasty involves the following steps:

• The procedure uses an instrument, usually a YAG laser, to burn 80 - 100 tiny holes in the drainage area.
• A tiny scar forms, which increases fluid outflow.
• The procedure takes 15 minutes, causes almost no discomfort, and has very few complications.

Laser surgery is not a cure. Patients still need to take anti-glaucoma eye drop medications every day. Within 2 - 5 years, about half of patients need either additional surgery or new medications.

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Complications. In about 35% of patients, pressure increases after surgery. In most cases it is temporary, but in rare cases the increased pressure is permanent and vision loss can occur. Use of the drug apraclonidine (Iopidine) or pilocarpine can help prevent this elevated pressure. About a third of patients also develop adhesive-like substances called peripheral anterior synechiae that cause the iris to stick to part of the cornea.

Drainage Implants (Tube Shunts)

Drainage implants, also known as tube shunts, may be used to drain fluid in certain cases, such as if glaucoma is not responsive to any standard procedure or is caused by certain conditions.

Candidates. Drainage implants may be useful in the following conditions:

• Glaucoma caused by swelling in the iris
• Glaucoma caused by abnormal vessel formations
• Iridocorneal endothelial (ICE) syndrome

The Procedure. In general, the procedure involves:

• An implant, most commonly a 1/2 inch silicone tube, is inserted into the eye's front chamber (anterior).
• The tube drains the fluid onto a tiny plate that is sewn to the side of the eye.
• Fluid collects on the plate and then is absorbed by the tissues in the eye.

Complications. Complications include:

• Hypotony (very low eye pressure) is a serious complication that has been reduced using better techniques and improved implants.
• Cataracts, detached retina, breakdown of the cornea, and bleeding are potentially significant complications.
• There is also a risk for eye movement disorders, such as strabismus (crossed eyes) or diplopia (double-vision).