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Hub AI
Glaucoma surgery AI simulator
(@Glaucoma surgery_simulator)
Hub AI
Glaucoma surgery AI simulator
(@Glaucoma surgery_simulator)
Glaucoma surgery
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.
A trabeculoplasty is a modification of the trabecular meshwork. Laser trabeculoplasty (LTP) is the application of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas. The two types of laser trabeculoplasty are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). As its name suggests, argon laser trabeculoplasty uses an argon laser to create tiny burns on the trabecular meshwork. Selective laser trabeculoplasty is newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork and create less thermal damage than ALT. SLT shows promise as a long-term treatment. In SLT a laser is used to selectively target the melanocytes in the trabecular meshwork. Though the mechanism by which SLT functions is not well understood, it has been shown in trials to be as effective as the older ALT. However, because SLT is performed using a laser with much lower power than ALT, it does not appear to affect the structure of the trabecular meshwork (based on electron microscopy) to the same extent, so retreatment may be possible if the effects from the original treatment should begin to wear off, although this has not been proven in clinical studies. ALT is repeatable to some extent with measurable results possible.[citation needed]
An iridotomy involves making puncture-like openings through the iris without the removal of iris tissue. Performed either with standard surgical instruments or a laser, it is typically used to decrease intraocular pressure in patients with angle-closure glaucoma. A laser peripheral iridotomy (LPI) is the application of a laser beam to selectively burn a hole through the iris near its base. LPI may be performed with either an argon laser or Nd:YAG laser.
There is currently no sufficient evidence to show any benefit on the use of iridotomy versus no iridotomy to slow down visual field loss. This is based on analysing four studies with a sample of 3,086 eyes of 1,543 participants; iridotomy seems to improve gonioscopic findings, but does not show to be clinically significant.
An iridectomy, also known as a corectomy or surgical iridectomy, involves the removal of a portion of iris tissue. A basal iridectomy is the removal of iris tissue from the far periphery, near the iris root; a peripheral iridectomy is the removal of iris tissue at the periphery; and a sector iridectomy is the removal of a wedge-shaped section of iris that extends from the pupil margin to the iris root, leaving a keyhole-shaped pupil.[citation needed]
Clear lens extraction, a surgical procedure in which clear lens of the human eye is removed, may be used to reduce intraocular pressure in primary angle closure glaucoma. A study found that CLE is even more effective than laser peripheral iridotomy in patients with angle closure glaucoma.
Filtering surgeries are the mainstay of surgical treatment to control intraocular pressure. An anterior sclerotomy or sclerostomy is used to gain access to the inner layers of the eye in order to create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, allowing aqueous to seep into a bleb from which it is slowly absorbed. Filtering procedures are typically divided into either penetrating or non-penetrating types depending upon whether an intraoperative entry into the anterior chamber occurs.
Penetrating filtering surgeries are further subdivided into guarded filtering procedures, also known as protected, subscleral, or partial thickness filtering procedures (in which the surgeon sutures a scleral flap over the sclerostomy site), and full thickness procedures. Trabeculectomy is a guarded filtering procedure that removes of part of the trabecular meshwork. Full thickness procedures include sclerectomy, posterior lip sclerectomy (in which the surgeon completely excises the sclera on the area of the sclerostomy), trephination, thermal sclerostomy (Scheie procedure), iridenclesis, and sclerostomy (including conventional sclerostomy and enzymatic sclerostomy).
Glaucoma surgery
Glaucoma is a group of diseases affecting the optic nerve that results in vision loss and is frequently characterized by raised intraocular pressure (IOP). There are many glaucoma surgeries, and variations or combinations of those surgeries, that facilitate the escape of excess aqueous humor from the eye to lower intraocular pressure, and a few that lower IOP by decreasing the production of aqueous humor.
A trabeculoplasty is a modification of the trabecular meshwork. Laser trabeculoplasty (LTP) is the application of a laser beam to burn areas of the trabecular meshwork, located near the base of the iris, to increase fluid outflow. LTP is used in the treatment of various open-angle glaucomas. The two types of laser trabeculoplasty are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT). As its name suggests, argon laser trabeculoplasty uses an argon laser to create tiny burns on the trabecular meshwork. Selective laser trabeculoplasty is newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork and create less thermal damage than ALT. SLT shows promise as a long-term treatment. In SLT a laser is used to selectively target the melanocytes in the trabecular meshwork. Though the mechanism by which SLT functions is not well understood, it has been shown in trials to be as effective as the older ALT. However, because SLT is performed using a laser with much lower power than ALT, it does not appear to affect the structure of the trabecular meshwork (based on electron microscopy) to the same extent, so retreatment may be possible if the effects from the original treatment should begin to wear off, although this has not been proven in clinical studies. ALT is repeatable to some extent with measurable results possible.[citation needed]
An iridotomy involves making puncture-like openings through the iris without the removal of iris tissue. Performed either with standard surgical instruments or a laser, it is typically used to decrease intraocular pressure in patients with angle-closure glaucoma. A laser peripheral iridotomy (LPI) is the application of a laser beam to selectively burn a hole through the iris near its base. LPI may be performed with either an argon laser or Nd:YAG laser.
There is currently no sufficient evidence to show any benefit on the use of iridotomy versus no iridotomy to slow down visual field loss. This is based on analysing four studies with a sample of 3,086 eyes of 1,543 participants; iridotomy seems to improve gonioscopic findings, but does not show to be clinically significant.
An iridectomy, also known as a corectomy or surgical iridectomy, involves the removal of a portion of iris tissue. A basal iridectomy is the removal of iris tissue from the far periphery, near the iris root; a peripheral iridectomy is the removal of iris tissue at the periphery; and a sector iridectomy is the removal of a wedge-shaped section of iris that extends from the pupil margin to the iris root, leaving a keyhole-shaped pupil.[citation needed]
Clear lens extraction, a surgical procedure in which clear lens of the human eye is removed, may be used to reduce intraocular pressure in primary angle closure glaucoma. A study found that CLE is even more effective than laser peripheral iridotomy in patients with angle closure glaucoma.
Filtering surgeries are the mainstay of surgical treatment to control intraocular pressure. An anterior sclerotomy or sclerostomy is used to gain access to the inner layers of the eye in order to create a drainage channel from the anterior chamber to the external surface of the eye under the conjunctiva, allowing aqueous to seep into a bleb from which it is slowly absorbed. Filtering procedures are typically divided into either penetrating or non-penetrating types depending upon whether an intraoperative entry into the anterior chamber occurs.
Penetrating filtering surgeries are further subdivided into guarded filtering procedures, also known as protected, subscleral, or partial thickness filtering procedures (in which the surgeon sutures a scleral flap over the sclerostomy site), and full thickness procedures. Trabeculectomy is a guarded filtering procedure that removes of part of the trabecular meshwork. Full thickness procedures include sclerectomy, posterior lip sclerectomy (in which the surgeon completely excises the sclera on the area of the sclerostomy), trephination, thermal sclerostomy (Scheie procedure), iridenclesis, and sclerostomy (including conventional sclerostomy and enzymatic sclerostomy).
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