Advanced Glaucoma Surgery: An Overview

Abstract

The current era in glaucoma surgical care has led to transformative treatment strategies for patients with late stages of the disease as well as those experiencing persistent complications in the postoperative period. Targeted micro-bypass stenting of Schlemm’s canal with multiple devices may soon offer an effective method for reliable intraocular pressure lowering. A novel use of ab-interno trabeculectomy procedure (Trabectome; Neomedix, Inc.) may assist in the management of angle-closure glaucomas. Lensectomy may play a pivotal role in the treatment paradigm for angle-closure glaucomas, as demonstrated by anterior chamber imaging studies. Gonioscopy-Assisted Transluminal Trabeculotomy offers an innovative ab-interno approach to trabeculotomy, with encouraging results demonstrated after 12 months of follow-up. A novel gel implant allows for access to the subconjunctival space and bypass of physiologic aqueous outflow routes via an ab-interno approach. Nonpenetrating glaucoma surgery may allow for safer outcomes when compared to trabeculectomy, but involves a longer learning curve. Treatment of the posterior ciliary processes with endocyclophotocoagulation allows for the treatment of plateau iris and angle closure. The Ex-Press Mini-Glaucoma Device may offer advantages to trabeculectomy in the treatment of complex glaucomas. The treatment of normal-tension glaucoma often necessitates surgical intervention with trabeculectomy and administration of an antifibrotic agent. A combined approach for Boston Keratoprosthesis, glaucoma drainage implant, and pars plana vitrectomy surgery may allow for better long-term outcomes in patients with corneal blindness. The Modified Schocket procedure provides an effective option for surgical management of glaucoma occurring after scleral buckling surgery. Ab-interno bleb needling procedures offer logistical, financial, and psychological advantages over conventional transconjunctival approaches. When managed appropriately, drainage of choroidal effusions and hemorrhage allows for a successful postoperative outcome. Surgical techniques offer definitive therapy for malignant glaucoma and include anterior or posterior iridozonulohyaloidotomy and anterior chamber reformation with intraocular lens pushback.