Open Angle Glaucoma Treatment
Once the diagnosis of glaucoma is made, the aim of treatment today is to reduce eye pressure, stop the damage to the optic nerve and prevent the progression of vision loss. The methods that can be applied for this purpose can be divided into three as drug treatment, laser treatment and surgical treatment.
Drug Treatment
The aim of open-angle glaucoma is to prevent damage to nerve fibers by reducing intraocular pressure. In the treatment of glaucoma with medication. There are many drops used. These drops reduce intraocular pressure through different mechanisms. While some glaucoma drugs reduce the production of intraocular fluid, others make it easier for intraocular fluid to leave the eye. The effectiveness of the treatment is observed by visual field examinations and monitoring of the optic nerve head cupping. Medical treatment is continued as long as the damage to the visual field is stopped. If not successful, a second drop is added. Again, if the eye pressure does not decrease, a third drop is added according to the understanding of the treating doctor. Before starting the drop treatment, it should be investigated whether the patient has heart-lung disease. Because some of the drops used in the treatment of glaucoma may cause breathing difficulties and heart rhythm disturbances. Therefore, such drugs should be used with caution. Some types of glaucoma drops can also cause blurred vision, eye pain, headache and allergic reactions. There are also some medications (tablets) that are used to reduce intraocular pressure and taken orally. However, these drugs are used for a few days to reduce intraocular pressure in a short time. If used for a long time, side effects such as disruption of blood electrolyte balance (especially potassium loss), numbness in hands and feet, and formation of kidney stones in the long term may occur. If the intraocular pressure in a patient with glaucoma remains at a normal level with drop treatment and this level is constantly maintained, the patient must use these drops continuously and regularly throughout life
Laser Treatment:< In the treatment of glaucoma, laser is a treatment option that can be applied before surgery in patients who do not respond adequately to drug therapy. Argon laser application to trabecular meshwork in glaucoma Laser treatment can reduce intraocular pressures that are not too high to normal levels. This application can reduce eye pressure by up to 30 percent. The duration of effect is usually around 2-3 years and its effect decreases significantly within 5 years. Then the intraocular pressure may rise again. Therefore, laser is a more suitable option only for pressures up to 26 mmHg and when you want to save time in patients who do not comply with drug treatment but cannot undergo surgery.
Surgical treatment:
If the intraocular pressure in a patient with glaucoma cannot be reduced to normal levels despite all the medications used, if the optic nerve damage progresses and the visual field gradually deteriorates, surgery becomes necessary. In addition, the doctor may find it necessary to perform glaucoma surgery early on in patients who have difficulty monitoring, disrupt medication use, do not comply, or do not come to check-ups. If surgery is postponed even though it is necessary, the patient will lose his vision day by day. Glaucoma surgeries are performed with general anesthesia if the patient is an infant or child, and with local anesthesia for adult patients. The procedure performed in the surgery is to facilitate the exit of the intraocular fluid, which has difficulty in leaving the eye and thus causes the intraocular pressure to increase. There are different techniques for this. Surgical methods used in open-angle glaucoma are trabeculectomy and viscocanalostomy. The aim of both methods is to open a channel that will allow the intraocular fluid to leave the eye easily. It is not necessary for the patient to lie down after the surgery. Sometimes after surgery, intraocular pressure may rise again. Then it may be necessary to perform glaucoma surgery a second time. In some types of persistent glaucoma, it is not possible to obtain results with standard surgical techniques. In this case, high intraocular pressure is tried to be reduced by placing some tubes (valves) in the eye. Visual field monitoring is very important after the surgery. After both laser and normal surgery, some patients may need to continue using medication or have repeated surgeries.
Closed Angle Glaucoma Treatment
Acute attack, which shrinks the pupil and reduces the secretion of intraocular fluid. It can be stopped with medications. When the intraocular pressure decreases to normal level, laser iridotomy must be performed. So laser A hole is made in the iris. Thus, the fluid in the posterior chamber can easily pass into the anterior chamber. This procedure is performed after anesthetizing the eye with drops and takes a few minutes. It can also be done on the other eye as a precaution. Because when the angle in one eye is narrow, there is a high probability that the other one will also be narrow. It can be understood whether the angle is narrow or wide with a technique called gonioscopy.
Read: 0
