Medical Health Encyclopedia

Supportive Medication for Preventing Scarring. Specific drugs, usually mitomycin C, are often used in conjunction with the procedure to prevent scarring and closure. A large meta-analysis on studies of mitomycin C supported its effectiveness in increasing surgical success in nearly all patients. Fluorouracil (5-FU) appears to be similar in effectiveness but has a high risk for complications and is not used as often as in the past.

Laser Trabeculoplasty

The Procedure. Laser trabeculoplasty involves the following steps:

• The procedure employs an instrument, usually a YAG laser, to burn 80 to 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.

In a 2-year study, laser surgery of the trabecular meshwork reduced pressure by one third in 70 - 97% of patients. Patients still need to take anti-glaucoma eyedrop medications every day.

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Laser surgery is not a cure. Within 2 to 5 years, about half of patients need either additional surgery or new medications.

Complications. In about 35% of patients, pressure increases after surgery. In most cases it is temporary, but rarely 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

Implants 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. Success rates are highest (75% pressure control over 5 to 7 years) in appropriate patients. 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