Not all operations are suitable for every patient. Age, individual risk factors for complications, type of glaucoma, extent of damage, concomitant diseases, etc. play a decisive role in the choice of the appropriate surgical technique. We always try to offer patient-oriented and individual surgical methods.
During cyclophotocoagulation, parts of the ocular fluid-producing cells of the radiating body (ciliary body) are destroyed by laser. This procedure has the goal of reducing the production of ocular fluid in comparison to all other procedures. In most cases, repeated treatments are necessary to stabilize the intraocular pressure in the medium and long term. This method is mainly used in advanced stages of the disease.
Trabeculectomy is a so-called fistulization surgery and the oldest established glaucoma surgery. In this procedure, an open connection ("fistula") for the ocular fluid from the anterior chamber under the conjunctiva is created by removing a small piece of sclera. A so-called seepage or filter cushion is created as a completely new drainage path for the eye fluid. The 4 to 6 weeks after the operation are also decisive for the success of the new drainage route, as the natural wound healing reaction can lead to a closure of the drainage route.
This is a more recent procedure that is suitable for open angle glaucoma. Deep sclerectomy differs from trabeculectomy in that it does not create a direct connection between the anterior chamber and the conjunctiva, but leaves an extremely thin layer of tissue with easier flow for the ocular fluid. The outflow is supported by a microimplant. A filter cushion is also created afterwards. The follow-up treatment is similar to that of trabeculectomy.
Canaloplasty is a more recent surgical technique in which the natural drainage channel (in this case the Schlemm's canal inside the eye) is dilated by means of a microcatheter and a gel or thread, thereby improving the flow of aqueous humor. In canaloplasty, no filter cushion is usually created. However, fluctuations in intraocular pressure may occur in the first few weeks, so that regular check-ups are also necessary in the first 4 weeks.
Minimally invasive glaucoma surgery is usually understood to be the insertion of small (micro) tubes or tubing into the chamber angle in order to achieve improved drainage of ocular fluid. These methods were developed to minimize the surgical trauma to the eye and to accelerate post-operative recovery. The experience is promising, but the microtubes can sometimes become blocked by the tissue in the eye. This type of microsurgery is constantly in development. The aim is to achieve a good pressure-reducing effect with minimal op risks.
Drainage implants have been used in glaucoma surgery for over 50 years. These are silicone tubes and hoses (suitable for the eye but much larger than those used in MIGS), which conduct the ocular fluid from the anterior chamber under the conjunctiva at the surface of the eye and behind the eye. These are efficient, but longer operations that are usually reserved for patients who have already had glaucoma surgery. This is crucial because the natural wound healing reaction can lead to a blockage of the drainage path.