Recent Advances in treatment of Glaucoma
Until recently, anti glaucoma surgery was a choice in cases of “Angle Closure glaucoma” with angle synechiar or in medically uncontrolled “Open angle Glaucoma” and the procedure was limited to Trabeculectomy.
This was a type of guarded filtering surgery where the damaged drainage angle of the anterior chamber was by passed and fluid from the eye was bled into the subconjunctival space. This is a highly successful procedure, even though it was associated with complications like infections, post operative hypotony with flat AC, hyphema and also late failure of filtration, cataractogenesis and Choroidal Detachment
One advancement was the use of antimetabolite drugs like Mitomycin-C along with Trabeculectomy – especially in young patients . This controlled inflammation and thus fibrotic failure of filtering bleb.
Newer methods like Deep Sclerectomy and Viscocanalostomy have revolutionized Anti Glaucoma surgery. Since there is no penetration of the AC complications mentioned in the case Trabeculectomy are avoided.
As the illustration demonstrates, in Deep Sclerectomy a second partial thickness flap is created below the outer conjunctival flap. This is excised to create a deep scleral pocket that forms an aqueous lake. Using implants like the T implant and collagen the aqueous is then drained into the suprachorsoidal space. This is much safer as it minimizes chances of over filtration, infection, and cataract formation. It Antimetabolites may also be used with this surgery.