Lasers and Surgeries For Glaucoma

At the Sakowitz Eye Center, we offer all types of medical, laser and Surgical therapies for glaucoma management. The following is a short description of the types of glaucoma lasers and surgeries performed by our doctors at the center.

Lasers for Glaucoma

Selective Laser Trabeculoplasty, SLT
Selective Laser Trabeculoplasty is done in patients with glaucomas with open angles who have been unsuccessfully on one or two eyedrops to lower the pressure. In selected patients it can be used as primary treatment.

Micropulse Laser Trabeculoplasty, MLT
This is a variant of Selective Laser Trabeculoplasty and has been shown to decrease intraocular pressure.

ND:YAG Peripheral Iridotomy, PI
This laser is done on patients with narrow angles either to prevent or break an attack of acute angle closure.  Long periods of angle closure can lead to elevated eye pressure and subsequent glaucomatous damage.

Argon Laser Iridoplasty, ALI
This laser is done in patients whose angles are very narrow in order to improve the configuration of the angle and help lower eye pressure.

Surgeries for Glaucoma

Trabeculectomy
Trabeculectomy is a traditional surgery performed usually on patients with uncontrolled glaucoma.  A partial thickness flap in the wall of the eye is created under which an opening allows filtration and subsequent reduction of eye pressure.

Express Shut surgery
A miniature shunt is placed underneath a partial thickness flap which allows drainage of the fluid within the eye.  This lowers the eye pressure. There is some research to suggest that the vision stabilizes sooner when an Express Shut is used.

Glaucoma drainage devices
These include, among others, the Ahmed Glaucoma drainage valve and the Baerveldt Glaucoma drainage shunt.  These shunts have external plates which are connected to the interior of the eye via silicone tubes.  The tubes drain the fluid from inside the eye to a fibrous ‘bleb’ that gets created around the plate, thus lowering the eye pressure.  A patch graft is usually placed over the tube to prevent erosion and exposure.

Bleb revisions and needlings
These procedures are done both after Trabeculectomy and after glaucoma drainage device surgeries in order to optimize the intraocular pressure which could be either too low or too high.

iStent with cataract surgery
This is a Minimally Invasive Glaucoma Surgical (MIGS) procedure.  The iStent in the smallest FDA approved eye pressure lowering device used in mild or moderate glaucoma which is placed into the drainage meshwork of the eye.  It is usually  placed immediately after cataract surgery is done in the eye, in the same setting.  The iStent is thought to create a bypass conduit from the anterior chamber of the eye into the natural drainage pathways, thus avoiding creating artificial drainage pathways like in traditional surgeries such as Trabeculectomy or after drainage devices.

Cataract surgery
Cataract surgery, in those patients with visually significant cataracts, has been shown to lower eye pressure in patients with elevated pressures where the angle of the eye is narrow because of the cataract.  Even in open angle patients, pressure lowering is seen in some cases.