1st order
- Argon laser or diode laser trabeculoplasty – this method increases aqueous humor outflow, thereby lowering intraocular pressure
- YAG laser iridotomy – incision of the iris to improve aqueous humor outflow.
- Diode laser cycloablation – destroying part of the aqueous humor-producing tissue and thus reducing aqueous humor outflow
- Trabeculotomy – incision of the trabecular meshwork, i.e., creation of a fistula, to improve aqueous humor outflow.
- Trabeculectomy – creating an artificial opening in the sclera, which is then loosely closed and covered with conjunctiva (this method remains the gold standard; high long-term success rates).
- Clearance of the blood in traumatic glaucoma.
For childhood glaucoma, surgery to lower intraocular pressure (IOP) is the treatment of choice (in congenital (congenital) glaucoma, there is almost an absolute indication for surgery/ usually trabeculotomy (see above) or goniotomy (incision of the tissue in the aqueous humor outflow area to improve outflow); in secondary glaucoma, in the majority of cases). In the simultaneous presence of primary narrow-angle glaucoma (POAG) and cataract (cataract), lens removal can result in a significant reduction in intraocular pressure (IOP). This is associated with a reduction in antiglaucomatous therapy or avoidance of trabeculectomy.
Further notes
- Selective laser trabeculoplasty (SLT): use of extremely short and high-energy laser pulses that act selectively on the melanin-containing pigment cells of the trabecular meshwork and do not thermally damage the trabecular meshwork. As a result of the body’s own healing process, the treated cells are degraded, which restores aqueous humor outflow.The LiGHT (“Laser in Glaucoma and ocular HyperTension“) study demonstrated that early laser therapy is highly effective. In 93.0% of laser-treated eyes, normal intraocular pressure was measured at regular check-ups compared with 91.3% of eyes treated primarily with medication; 74.2% of patients no longer required eye drops 36 months after laser therapy.
2nd order
- Deep sclerectomy – method of improving aqueous humor outflow that does not open the anterior chamber of the eye.
- Viscocanalostomy – further development of deep sclerectomy; method is also used to improve aqueous humor outflow; the anterior chamber of the eye is not opened here either
- Insertion of artificial-filtrating shunts – in this method, a drainage tube, which creates a pressure balance, is inserted into the anterior chamber of the eye
