Glaucoma surgery

Purpose Discussion of surgical management of different types of glaucoma. Methods In congenital glaucoma early surgical management is indicated (goniotomy). In acute angle‐closure glaucoma immediate treatment is imperative (laser iridotomy or surgical iridectomy). In chronic angle‐closure glaucoma management depends on the evolution and duration of the process:a) Peripheral iridectomy. b) Non‐perforating trabeculectomy. c) Perforating trabeculectomy.d) YAG laser cyclocoagulation. In chronic simple glaucoma medical therapy is indicated if permanent (24 hours) response of the pressure is obtained. If not lamellar trabeculectomy with peripheral iridectomy and application of mitomycine is attempted. In severe chronic simple glaucoma perforating trabeculectomy with mytomycine is indicated. Results In case of flat anterior chamber, with hypertension, malignant angle closure glaucoma is suspected. Management: a) Posterior sclerotomy. b) Vitreous aspiration. c) Reformation of the anterior chamber with air and Healon. d) Application of atropine 4%. If an incipient cataract is present simultaneous sonophako with IOL implantation is indicated. In case of flat anterior chamber with ocular hypotension instillation of 4% atropine and posterior sclerotomy for evacuation of the choroidal detachment, followed by restauration of the anterior chamber with air, is indicated. Conclusion The main symptom of glaucoma is persistent increase of intraocular pressure which generally requires surgical intervention. The individual management has to be carefully selected according to the different types of the disease.