Chapter 112 - Glaucoma surgery

Summary

Glaucoma is the most common cause of optic neuropathy. Many ocular conditions may lead to the development of glaucomatous nerve damage. In general, therapeutic interventions are directed towards lowering intraocular pressure, a key risk factor for disease progression.

Typically, therapy begins with topical medications, the first and simplest option. These include the prostaglandin analogs, beta adrenergic receptor blockers, carbonic anhydrase inhibitors, alpha adrenergic agonists, and miotics. These agents are used alone or in combination, and are often sufficient to control intraocular pressure. In cases of open-angle glaucoma, laser trabeculoplasty may also be used to lower intraocular pressure. Laser interventions are performed in the clinic either alone or in combination with medical therapy. For cases of angle-closure glaucoma, laser iridotomy may be performed to either treat or prevent pupillary block (iris-lens diaphragm obstruction), an anatomic predisposition that is responsible for the majority of cases. Cyclodestructive surgery (intentional destruction of the ciliary body tissues) is another laser procedure that may be used when other interventions have failed, including incisional surgery. These procedures, which are usually performed in the clinic under local anesthesia, are commonly performed with lasers and, less commonly, cryotherapy.