Most people know that glaucoma has something to do with high eye pressure.
This pressure is the result of fluid that cannot get out of the eye.
Because it is trapped, pressure increases, and destroys the optic nerve.
If not successfully treated, the result is loss of vision and blindness.
Traditional glaucoma surgeries like trabeculectomy are called "penetrating" surgeries.
A hole is made in the white part of the eye to allow fluid out.
This fluid (aqueous humor) exits the eye into what is called a bleb.
However, if the connection from the inside of the eye to the bleb scars down the surgery fails.
A recent survey says that approximately 28% of patients are dissatisfied with their glaucoma filtering procedures.
Why so many? It is generally thought that glaucoma filtration surgeries like trabeculectomy are supposed to preserve vision in glaucomatous eyes when pressure is kept at a lower level.
What is going wrong? When trabeculectomy creates a "controlled" leak of fluid (aqueous humor) from the eye, a small conjunctival "bleb" (bubble) appears at the junction of the cornea and the sclera (limbus) and lowers intraocular pressure (IOP).
However, the bleb undergoes a normal process of wound healing too.
Experts believe that scarring in the subconjuctival space may have bridged the gap opening, causing the filtering surgery to fail.
Therefore, modulating the wound healing process can play a major role in improving the outcome of glaucoma filtration surgery.
Researchers have directed considerable attention toward pharmacologic techniques that interfere with wound healing.
They have found that antimetabolites like 5-fluorouracil (5-FU) and mitomycin-C (MMC) can be used as adjunctive therapy to prevent excessive scar formation in glaucoma surgery.
However, both 5-FU and MMC are associated with significant complications such as extremely low IOP, long-term risk of infection, and vision loss.
As a result, many surgeons are considering alternative surgical approaches to minimize these ocular complications.
Canaloplasty, for example, is a novel surgery that reduces IOP by shunting aqueous humor through the eye's natural drainage duct.
Compared to other minimally invasive IOP-lowering procedures, Canaloplasty is more patient-friendly, and safer than trabeculectomy.
If there is a significant negative associated with canaloplasty, it is that the procedure takes dedication, patience, and skill to master.
From the patient's perspective, however, it may be worth finding such a surgeon as most patients who are candidates for Canaloplasty enjoy fewer post-operative problems than patients who undergo trabeculectomy.