Glaucoma Surgery

Treat Glaucoma with eye surgery at Green Apple Eye Care

Glaucoma can be effectively treated with eye surgery, and our glaucoma surgeon, Dr. Memmen, is world renowned for his expertise at many surgical procedures including selective laser trabeculplasty, trabeculectomy and EX-PRESS Glaucoma Filtration Device surgery.

When is open-angle glaucoma surgery necessary?

Most cases of open-angle glaucoma begin treatment with medicated eyedrops or laser treatments. When these treatments do not successfully lower your intraocular pressure enough to avoid further optic nerve damage, surgery is usually recommended. Glaucoma surgery improves the flow of fluid out of the eye, resulting in lower eye pressure.

As with any surgery, no matter how simple or routine, there are always inherent risks. However, those risks should be discussed with Dr. Memmen and balanced against the greater risk of leaving glaucoma untreated and losing your vision.

Surgery Options:

Trabeculectomy

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Of the possible procedures, glaucoma filtration surgery, also called trabeculectomy, is the most common.

How is a trabeculectomy done? In performing a trabeculectomy, Dr. Memmen makes a small flap in the outer white coating of the eye, called the sclera. A filtration bleb, or reservoir, is created under the conjunctiva, the thin and clear coating that covers the sclera. The aqueous humor inside the eye can then drain through the flap to collect in the bleb, where it is absorbed into the lymph and blood vessels around the eye. After the bleb is carefully constructed, the incision is closed with tiny stitches. Some of these stitches may be removed after surgery to increase fluid drainage. Drugs to reduce scarring are often applied during and after surgery.

What can you expect if you have a trabeculectomy?
Before Surgery: You will continue to use your glaucoma medications until just prior to surgery, as directed by Dr. Memmen. The precise timing for stopping and resuming all of your other medications including Coumadin or any anticoagulants, and aspirin or any products containing aspirin should be coordinated with your internist, cardiologist and ophthalmologist.

Day of Surgery: Our glaucoma surgeon, Dr. Memmen, performs the trabeculectomy as an outpatient surgery in a hospital or surgery center. A local anesthetic is used to prevent discomfort during the operation. You may be given a sedative to help you relax. General anesthesia is rarely necessary. The procedure is usually performed in less than one-half hour, but it may take longer if you have had previous eye surgery, if your eye is inflamed, or if abnormal blood vessels are present.

You will be unable to drive after surgery, so you will need to arrange for transportation home.

After Surgery:Postoperative care is just as important to the long-term success of the operation as the surgery itself. In follow-up appointments, Dr. Memmen will examine the filtering bleb, the external appearance of the eye, your eye pressure, and the back of your eye. You should avoid lifting, bending, or straining after surgery until your eye pressure stabilizes.Pain is unusual after surgery, although your eye may feel tender and sensitive. A non-aspirin pain reliever is usually sufficient to treat any discomfort. Sudden, severe, or deep-seated pain, especially if it is associated with loss of vision, should be reported to Dr. Memmen immediately.

What will my vision be like?
You may expect significant blurring or fogging of your vision in the early post-opertative stages. Daily fluctuation in your vision after surgery is also expected. Generally, you will see gradual improvement of your vision over several weeks. There may or may not be a change in your eyeglass prescription after surgery. Vision may not return to “normal” if a cataract is present or another complication exists. Dr. Memmen will discuss your personal expectations and likely visual results. Surgery can prevent further damage caused by glaucoma but it cannot usually restore vision already lost from glaucoma.

What are the risks of Trabeculectomy surgery?
While complications during a trabeculectomy are very rare, some risks include:

scarring
infection
bleeding
wound leakage
over filtration
loss of vision
premature development of a cataract

Although the success rate is quite high, sometimes a single surgical procedure cannot halt the progression of glaucoma. Another surgery, continued treatment with medications, or both may be necessary.
An eye that has undergone a trabeculectomy and has a functioning bleb will always be susceptible to infection. A red, uncomfortable eye may be a sign of infection and requires urgent medical attention.

Selective Laser Trabeculoplasty (SLT)

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Selective Laser Trabeculoplasty (SLT) uses a neodymium: YAG laser to focus light energy on the trabecular meshwork (internal drainage channel) of the eye. SLT targets the pigmented (melanin-containing) cells in the trabecular meshwork using a very short application of light. The surrounding tissue is not damaged because SLT uses a low amount of energy. The treatment allows the drain to work more efficiently, successfully lowering eye pressure more than 80% of the time.

After a successful SLT, many patients continue to use eyedrops to maintain a safe intraocular pressure. This procedure is typically not used as a long-term or permanent solution because, over time, eye pressure may return to increased levels. By five years, up to half of people treated with SLT experience a rise in eye pressure. Dr. Memmen will need to continue to monitor your eye pressure and can repeat the SLT treatment if needed.

However, this laser surgery can reduce the amount of medication you need and is often recommended as a first line of glaucoma treatment for those who have trouble using eye drops.

How is SLT done?The procedure is done in Dr. Memmen’s office and usually takes less than 2-3 minutes. First, anesthetic eye drops are used to numb the eye. Additional drops are given to control eye pressure. While you are seated at the examining microscope, the laser energy is then focused through a lens to treat the trabecular meshwork (drainage channel). You will experience a flash of light with each laser application. Discomfort is rarely associated with this glaucoma treatment.
Your vision will be blurred immediately after treatment but should clear within just a few hours. Most people can return to their normal activities the day after the glaucoma laser surgery.It will take several weeks for the laser treatment to take full effect. Dr. Memmen will want to check your eye pressure one to two months after the procedure. If your eye pressure is not lower at the first visit, some additional effect can be gained up to three months after treatment.

If lower eye pressure needs to be attained, Dr. Memmen will help you decide whether additional laser treatment, medication, or surgery is required.

What are the risks of SLT?
Although rare, possible complications include:

Failure to adequately lower the eye pressure
Inflammation in the eye causing pain, redness, or blurred vision

Aqueous Shunt Surgery

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This surgery is an alternative procedure when a trabeculectomy cannot be performed that may successfully lower your intraocular pressure.

What is aqueous shunt surgery? How does a shunt work?Depending on the patient’s needs, Dr. Memmen will either use a large shunt (tube) called an Ahmed Shunt or Baerveldt Shunt, or a small shunt called the Ex-PRESS Glaucoma Filtration Device (or mini shunt).

The Ex-PRESS mini-shunt is a relatively new device, available in the USA since 2002. Over 12,000 implantations have been performed worldwide. It is a straightforward procedure in which Dr. Memmen diverts the fluid through an extremely small tube to the outside of the eye. He neither cuts the sclera, nor the iris. Although the device is as small as a grain of rice, it acts just like a heart stent, keeping a pathway open so blood (or fluid) can successfully go around the blockage.

The Ex-PRESS provides precise control of the amount of fluid that is allowed to flow out, helping the eye maintain a healthy level of internal pressure. The shunt provides effective long term control of intraocular pressure, with a success rate of about 94%. It can be done following, or along with, cataract surgery.

The Ex-PRESS has an equally effective intraocular pressure control compared with trabeculectomy, but is safer than trabeculectomy in the short term. In most cases, patients virtually eliminate their need for glaucoma eye drops after surgery.

“It isn’t often that a patient/doctor relationship develops through the years as one of total trust. Dr Memmen displays a commitment to patients that exceeds designated time restraints found in many professional visits. His dedication to providing the best possible care, physically and emotionally, for his patients is unparalleled. His positive attitude has carried me through Glaucoma surgery, cataract surgery and more. And I so appreciate his personal calls to check on my progress. Out of all the specialists I have seen, he stands tall as the best possible doctor. I would recommend Dr. Memmen anywhere, any time, and totally believe in his expertise!”

– Jan Forkert, Ellison Bay, WI

“Their wonderful staff is warm, friendly and very skilled. Dr. Memmen is #1 in my book because he’s patient, knowledgeable and honest. He consistently has great communication and bedside manner. Dr. Memmen explained my procedure in detail. His follow-up care is always great! It’s the best medical care opportunity and a great office. My mom is now patient there, and I want her to receive from BEST! Need I say more?
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– Maritza Perez, WI