Glaucoma

Glaucoma is a group of eye diseases in which there is a progressive atrophy of the optic nerve, progressing with characteristic lesions in the appearance of the optic nerve disc II and progressive defects in the visual field. A plurality of clinical symptoms reported by patient depends on the type of glaucoma. There are many kinds of this disease, a common characteristic of which is optic nerve damage leading to blindness. Glaucoma is a chronic disease, so one should always strive to achieve a therapeutic success with the least possible inconvenience of treatment, costs and side effects.

The treatment of glaucoma

The treatment of glaucoma aims to prevent the deterioration of vision or to minimise the effects of the disease development, resulting from the development of the disease. The aim of therapeutic approach according to the European Society of Ophthalmology is to maintain visual function to an extent corresponding to the individual needs of the patient. The main goal of the treatment of glaucoma is to lower intraocular pressure and reach the target pressure, which is the estimated value of the pressure that we want to obtain, at which no further glaucomatous damage progresses. There are 3 groups of hypotensive agents used in the treatment of glaucoma:

  • medicines
  • laser procedures
  • surgical treatment.

Depending on indications, we can use the above-mentioned agents separately or combine therapies. Effective treatment of glaucoma should in any case adapt therapeutic proceeding strategy to the individual needs of each patient. Indispensable is also the awareness of patient, who should learn the nature of the disease, as well as the types and the sense of applied therapies.

Cooperation of an ophthalmologist with an aware patient allows to fully achieve the goal, which is to preserve vision appropriately to the needs of the patient to the end of its life, without disturbing its daily activities and with minimal side effects of the treatment.

In the hospital we conduct the treatment of glaucoma through the use of both conservative and surgical methods.

The strategy of surgical treatment is adjusted individually for each patient. The performed operations are aimed at facilitating the outflow of aqueous humour from the eye ball and lowering the intraocular pressure. At MAVIT MC in Warsaw we perform the following types of glaucoma surgeries:

  • non-penetrating operations: deep sclerectomy, canaloplasty
  • penetrating operations: intrasclerotic peripheral iridencleisis, trabeculectomy
  • operations using draining implants
  • MIGS – a group of micro-invasive procedures using implants.

Depending on the indications, procedures can be performed either with the combined use of antiproliferative preparations (Mitomycin C – intra-operatively and 5-Fluorouracil – post-operatively), or with the simultaneous cataract removal.

Non-penetrating operations

The most frequently performed antiglaucomateous procedure is deep sclerectomy. This is a non-penetrating operation, that is such in which no transmural opening of the eye ball occurs. It involves the removal of the outer wall of Schlemm’s canal, the formation of the filtering membrane, through which the aqueous humour out of the eye ball, as a result of the pressure difference, is percolated to the decompression space formed in the sclera. The operation acts through the thus prepared outflow pathways (subconjunctival, suprachoroidal, intrasclerotic, and conventional pathway through the Schlemm’s canal), effectively reducing and stabilising the intraocular pressure. The surgery itself is safe, that is associated with a negligible number of complications. In order to maintain the decompression space and subconjunctival outflow after the procedure, thereby increasing the post-operative success, there I used a special substance – Healaflow or the anterior capsule of the patient’s own lens – in the case of simultaneous cataract removal.

Canaloplasty is a modern surgical technique, which aims at increasing the outflow of aqueous humour from the eye using conventional pathway, that is through the Schlemm’s canal. The operation involves filling the Schlemm’s canal with viscoelastic substance and tensing its walls by introducing prolene thread. In the post-operative period the control scheme is similar as in the case of cataract.

Penetrating operations

They are characterised by high efficiency, but are associated with a higher number of complications than non-perforating operations, inter alia: hypotonia (very low intraocular pressure) and its consequences: reduction in the eye anterior chamber depth, choroidal detachment and macular oedema. The most frequently performed at MAVIT MC operation of this type is intrasclerotic peripheral iridencleisis. This operation involves the placement of a portion of cut iris under the preformed sclerotic flap and the formation of a new pathway of the outflow of aqueous humour from the anterior chamber beneath the conjunctiva.

Trabeculectomy involves excision of a part of the trabecular structure using a special trephine under the preformed sclerotic flap. Both operations are associated with the formation of a filtering bubble in the post-operative period, which is characterised by a small elevation on the eye ball under the upper eyelid.

Ex-PRESS™ implants used as a modification of trabeculectomy are implanted under the sclerotic flap into the anterior chamber. The operation works similarly as the classic penetrating operations – on the basis of the formed filtering bubble.

Operations using draining implants

These procedures, also known as seton operations, are reserved for cases in which there is no normalisation of intraocular pressure, despite maximum conservative treatment and previous antiglaucomateous operations. In operations of this type the reservoir portion is positioned under the conjunctiva, while the drainage portion in the form of a thin tube is positioned in the anterior or posterior chamber.

Micro-invasive glaucoma surgery

This group of operations includes all surgical interventions that do not require dissection of the conjunctiva tissue. They are performed from the ab interno access, or from the side of the anterior chamber of the eye. At present, there are performed operations on the Schlemm’s canal using iStent and Hydrus implants, as well as operations forming the subconjunctival outflow using XEM implant. Such operations can be performed even in patients at an early stage of glaucoma.


The strategy of surgical treatment is adjusted individually for each patient. The performed operations are aimed at facilitating the outflow of aqueous humour from the eye ball and lowering the intraocular pressure.

At MAVIT MC in Katowice we perform the following types of glaucoma surgeries:

  • non-penetrating operations – deep sclerectomy
  • penetrating operations – trabeculectomy and intrasclerotic peripheral iridencleisis
  • operations using draining implants (SOLX® Gold Shunt, Ex-PRESS™ Mini Glaucoma Shunt, iStent Trabecular Micro-bybass Stent)
  • endoscopic cyclophotocoagulation (ECP) – isolated or with simultaneous cataract removal

Depending on the indications, procedures can be performed either with the combined use of antiproliferative preparations (Mitomycin C – intra-operatively and 5-Fluorouracil – post-operatively), or with the simultaneous cataract removal.

Non-penetrating operations

The most frequently performed at MAVIT MC procedure is deep sclerectomy. This is a non-penetrating operation, in which no transmural opening of the eye ball occurs. It involves the removal of the outer wall of Schlemm’s canal, the formation of the filtering membrane, through which the aqueous humour out of the eye ball, as a result of the pressure difference, is percolated to the decompression space formed in the sclera. The thus prepared outflow pathways (subconjunctival, suprachoroidal, intrasclerotic, and conventional pathway through the Schlemm’s canal) effectively reduce and stabilise the intraocular pressure, while the surgery itself is safe and associated with a negligible number of complications.

Penetrating operations

They are characterised by high efficiency, but are associated with a higher number of complications than non-perforating operations, inter alia: hypotonia (very low intraocular pressure) and its consequences: reduction in the eye anterior chamber depth, choroidal detachment and macular oedema. The most frequently performed operation of this type is trabeculectomy. This operation involves the excision of a part of the trabeculation along with the Schlemm’s canal and the formation of a new pathway of the outflow of aqueous humour from the anterior chamber to the subconjunctival space. Trabeculectomy is associated with the formation a filtering bubble, characterised by a small elevation on the eye ball under the upper eyelid and a small cut out of the peripheral iris, the so called parabasal iridectomy.

Operations using draining implants

The most innovative type of antiglaucomateous operations performed at MAVIT Medical Centre are the operations using the Micro-Stents forming new pathways connecting the anterior chamber with the suprachoroidal space, subconjunctival space and the Schlemm’s canal, thereby facilitating the outflow of aqueous humour from the eye ball in order to normalise the intraocular pressure.

For this type of surgery there are used:

  • gold plates with microchannels, implanted into the suprachoroidal space
  • Micro-Stenty Ex-PRESS™ – used as a modification of trabeculectomy, implanted under the sclerotic flap into the anterior chamber
  • titanium iStents using a physiological pathway of the outflow of aqueous humour, implanted into the Schlemm’s canal from the inside of the anterior chamber.
ECP – endoscopic cyclophotocoagulation

The ECP operating methods, using the latest endoscopic technology of visualisation, are considered to be very effective, with a small number of complications. During an operation using this method, a surgeon performs the laser therapy in the area of the ciliary body directly responsible for the production of aqueous humour and an increase in the intraocular pressure. Operations are performed in a fully controlled way, which significantly increases the safety and predictability of the effects of treatment. The ECP is used in almost all forms of glaucoma. Operations can be performed either with cataract removal, or as independent operating procedures. Currently, the ECP method is also used during a first-line treatment.

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