Canaloplasty
Deep Sclerectomy with Collagen Implant
Exress Mini-Shunt
Glaucoma is a leading cause of blindess in the world, there are 3 million Americans affected and every year 100,000 go blind from glaucoma. It can be prevented but once developed the vision loss is not correctable.
Causes : While there are many types of glaucoma they all result in death to the eye nerve (optic nerve). Nerve damage occurs from elevated eye pressure because of too much fluid (overproduction or decreased exit of fluid) inside the eye or from sub-optimal blood circulation to the nerve. Nerve damage from glaucoma causes small holes in the vision which can spread to large areas of vision loss. Of the two major kinds, narrow angle glaucoma can cause pain and rapid loss of vision, while open angle glaucoma has no obvious symptoms and steadily destroys the optic nerve. That is why after the age of 50 yearly eye exams are a good habit to have.
Choices in Glaucoma surgery:
CANALOPLASY: This new and less invasive glaucoma surgery was approved by the FDA in January of 2007. Canaloplasty has been an incredible addition to our office, in the care of patients since it’s adoption in February of 2007. My results have propelled me in continuing its use. In the 22 cases done, 20 are off of all medications with an average intraocular pressure (IOP) of 13mmHG. That is a great result if I do say so myself. The other two patients have lower pressures than before the procedure and are taking less medication. There are two years of research available in the USA and three years in Europe. The main argument against it is the newness, and the lack a long success record. Because it is less invasive with a lower complication rate than the “standard of care” Trabeculectomy surgery, it is now my first choice in most glaucoma patients that need more than medications and laser. Having Canaloplasty does not prevent one from later having Trabeculectomy or other glaucoma surgeries in the future. If you are suffering from glaucoma and the medications involved in its treatment and want another option, consider Canaloplasty.
TRABECULECTOMY is the classic glaucoma surgery usually recommended, and works by making an opening in the eye that allows the intraocular fluid to exit the eye another way. It is very effective but can have immediate and late complications. Dr. Mellgren performed this for the first 5 year of her practice but has been searching for a glaucoma procedure with a more predictable post-operative course and less complications. Some patients may have to have this type of surgery if their disease process is too developed. Dr. Mellgren offers standard trabeculectomy and a form of it called the Express mini-shunt which works by creating a bypass by placing a stainless steel mini-tube from the outside of the eye to the inside to allow aqueous to get out a different pathway.
DEEP SCLERECTOMY WITH COLLAGEN IMPLANT (DSCI) is a non-penetrating surgery to lower eye pressure without creating a penetration to the eye. For the past 6 years Dr. Mellgren has been doing DSCI procedures and is having excellent results with pressure control on the average of 13.5mmHg without medications.
Target pressure – This is a very important concept that will vary for each individual glaucoma patient. A large population study has revealed that in general if one has a diagnosis of glaucoma with some visual field loss ( which is nerve damage) the visual loss did not progress if the intraocular pressure (IOP) was always 16mmHg or below. That makes this number 16 the universal target to achieve to protect one from further optic nerve cell death. But the plot thickens because corneal thickness is must be taken into account. A thinner cornea will give a lower pressure than actual and a thicker cornea will give a falsely lower eye pressure reading. Your doctor will be considering these issues in setting your target pressure. Also, depending on the stage of seriousness of the nerve damage lower targets may be necessary. It is good for glaucoma patients to be involved in their IOP target and success at achieving it.
Glaucoma Surgery - When medical and laser treatments don’t accomplish Intraocular pressure control adequate to stop the disease (target pressure), surgical treatment is recommended. Fortunately today there are more options regarding this than in the past few years. Dr. Mellgren offers the following surgeries depending on the target pressure goal for the individual patient.
