TREATMENT OF GLAUCOMA AND OCULAR HYPERTENSION
SPECIALISTS IN GLAUCOMA OPERATIONS IN MADRID
Ocular hypertension occurs when the intraocular pressure (IOP) is higher than normal. Normal values are all those pressures that range between 11 and 21 millimetres of mercury (mmHg).
The fundamental difference between these two concepts is that in the case of glaucoma there is already a damage in the optic nerve and in the case of hypertension the optic nerve does not have to be damaged.
GLAUCOMA: WHAT IS IT, TYPES AND CAUSES?
Glaucoma is a neurodegenerative pathology, characterised by the progressive loss of the fibres of the optic nerve, which is damaged as a consequence. Ocular hypertension is the main risk factor when developing glaucoma, although there are also other very important risk factors, such as age or positive family history.
Glaucoma causes a progressive loss of visual field (peripheral vision) that, later, ends up affecting central vision in its more advanced stages. One of the main risks of glaucoma is that it is an asymptomatic, painless and irreversible disease. It is the main cause of irreversible blindness in the world.
The main risk factor when developing glaucoma is ocular hypertension, although there are also other very important risk factors such as age or family history.
Glaucoma causes a progressive loss of the visual field (peripheral vision), which later affects central vision in its most advanced stages.
One of the main risks of glaucoma is that it is an asymptomatic, painless and irreversible disease. It is one of the main causes of irreversible blindness in the world.
WHO IS AT RISK FOR GLAUCOMA?
The risk of suffering Glaucoma can vary according to many factors, however, these will not be determinant for the development of the pathology.
One of the main factors influencing the onset of glaucoma is age; people assume a greater risk from the age of 50 onwards, and as the years progress, the likelihood of developing glaucoma increases.
Other risk factors to consider are:
HOW DO I KNOW IF I HAVE GLAUCOMA?
There are different methods of treating glaucoma by controlling intraocular pressure. A diagnosis and early treatment is fundamental to be able to adequately treat this disease, since damage to the optic nerve can not be reversed.
At the Martínez de Carneros Ophthalmological Clinic we have several ways to treat glaucoma.
In the initial stages, the treatment can be medical, through the use of hypotensive eye drops. There is also the possibility of treating glaucoma by laser, which creates small perforations in the iris that help to release intraocular pressure. This treatment is done on an outpatient basis and does not require hospitalisation.
For this reason, the only way to detect glaucoma is through periodic ophthalmological check-ups, since most people with incipient glaucoma do not have symptoms and when they begin to suffer them is when changes in lateral or peripheral vision have already been observed.
Early detection of the pathology will be very important to stop the advance and avoid a loss of vision.
There are different methods of treating glaucoma by controlling intraocular pressure. Early diagnosis and treatment is essential in order to adequately treat this disease, as damage to the optic nerve cannot be reversed.
At the Martínez de Carneros Ophthalmological Clinic we have several lines of glaucoma treatment.
Pharmacological treatments are very useful when the detection of the pathology is early. In this case we can use hypotensive eye drops to control intraocular pressure.
There is also the possibility of treating glaucoma by laser, which creates small holes in the iris that help release intraocular pressure. This treatment is done on an outpatient basis and does not require hospitalization.
When none of the above treatments is sufficient, glaucoma operation, trabeculectomy, EPNP or surgery with valvular implants should be used, which consists of carrying out an exit route of the aqueous humour (fluid inside the eye) from the anterior chamber to the subconjunctival space, thus releasing a large part of the intraocular pressure.
At Clínica Oftalmológica Martínez de Carneros we are aware of the importance of a correct medical and surgical approach to glaucoma, which is why we have a highly specialized area dedicated to the prevention and treatment of this pathology.
TYPES OF GLAUCOMA
Open-angle glaucoma: According to the amplitude of the iridocorneal angle (angle that describes the root of the iris and the cornea) we find open-angle glaucoma, which represents more than 90% of cases and is caused by slow obstruction of the channels of drainage and the consequent rise of intraocular pressure. This pathology develops practically asymptomatic and slow.
Closed angle glaucoma: characterised by an acute closure of the aqueous humour drainage channels. It represents 5% of glaucomas and despite being less frequent, it has a much faster and more noticeable development. It requires immediate medical attention.
Congenital glaucoma: developed in infants and young children, and often of genetic origin.
Primary or secondary glaucoma: Depending on whether there is another disease that causes it, glaucoma is classified as primary or secondary.
Among the secondary glaucomas we would like to highlight the following for their special importance:
Pigmentary glaucoma: produced by the pigmentary dispersion syndrome. The pigment epithelium of the iris releases pigment granules that accumulate in the trabecular meshwork, one of the drainage pathways of the aqueous humour.
Pseudoexfoliative glaucoma: produced by a disease known as pseudoexoliacion syndrome. It is manifested by the progressive accumulation of extracellular material in different tissues and ocular structures, such as the iris, the anterior capsule of the lens or the iridocorneal angle, one of the ways out of the aqueous humour. It is related to age and genetics.
Neovascular glaucoma: manifested by the formation of new blood vessels in the iris and in the iridocorneal angle, which prevent the aqueous humour of the eyeball from circulating normally, considerably raising the intraocular pressure.
HOW IS GLAUCOMA TREATED?
Glaucoma surgery will be the last resort for treatment.
It is performed when the eye drops and laser have not been enough to lower the intraocular pressure. Through surgery, a new opening is made so that the aqueous humor can leave the eye.
This type of intervention is performed in the operating room as an outpatient and local anesthesia.
GLAUCOMA SURGERY TECHNIQUES
It consists of removing part of the tissue of the eye to create a new channel that drains the aqueous humor.
A drainage route of the aqueous humor is opened through a membrane of few microns allowing to reduce the intraocular pressure by filtration.
The placement of drainage devices or valves is a glaucoma surgery that, through a tube, connects the intraocular space with a reservoir or plate that is placed in the subconjunctival space of the eye.
HOW IS THE GLAUCOMA OPERATION PERFORMED?
First, a prior examination is performed to evaluate the actual condition of the glaucoma. Afterwards, the type of surgical technique to be used will be decided. Finally, the surgeon will make a personalized follow-up during the postoperative period to evaluate the evolution of glaucoma.
During the postoperative period, the ophthalmologist monitors and assesses the state of the fistula and the scar reaction, performing maneuvers that increase or decrease the healing depending on the needs of each patient.