A trabecular micro-bypass stent (iStent) is a new minimally invasive surgical option for glaucoma patients that is quickly growing in popularity. This procedure enhances the eye’s natural drainage system. During this surgical procedure a small implant is placed inside Schlemm’s canal through a small opening in the cornea. This results in lower intraocular pressure by redirecting the flow of the aqueous humour from the anterior chamber straight into the Schlemm’s canal. This procedure is most often performed at the same time as cataract surgery. It is suitable for patients with mild to moderately elevated intraocular pressure. The implant is made of titanium and is safe if the patient needs an Magnetic Resonance Imaging (MRI) scan in the future.
GATT
Gonioscopy Assisted Transluminal Trabeculotomy (GATT) is a newer surgical treatment for glaucoma that is safer and very effective. When the drainage pathways for fluid inside of the eye are not working effectively, this procedure will help to reduce intraocular pressure by restoring the natural outflow pathway. GATT is an outpatient procedure, which takes less than one hour and is usually completed with local anaesthesia and optional intravenous sedation. During the procedure, the ophthalmologist creates a very small incision to access Schlemm’s canal (the eye’s natural drainage system). A micro-catheter or suture is then passed 360 degrees through the canal, creating a loop. As this loop is externalized from the eye, it opens the trabecular meshwork from the inside, and the trabeculotomy is now complete. Removal of the trabecular meshwork enhances the natural pathway for aqueous outflow into Schlemm’s canal, decreasing intraocular pressure.
There are several benefits to the GATT procedure as compared to the traditional trabeculectomy. GATT allows access to all of Schlemm’s Canal and the trabecular meshwork without an incision of the conjunctiva and sclera. The procedure is less invasive; there is less scar tissue, no formation of a conjunctival bleb, and fewer post-operative complications. Further down the road, it is still possible to perform traditional glaucoma surgery if it is necessary. GATT is considered a MicroInvasive Glaucoma Surgery (MIGS) that is capable of managing high pressures without forming a bleb.
XEN Gel Stent
The XEN gel Stent is a new microinvasive approach to the treatment of glaucoma. XEN gel stent implantation is performed in the operating room under local anesthetic with optional intravenous sedation. The XEN stent is a small tube that is placed in the eye to make a new permanent pathway for the fluid to drain and thereby reduce the intraocular pressure.
Unlike traditional methods, it is a minimally invasive procedure that should significantly reduce complication rates. The stent itself is a collagen-derived gelatin about 6mm in length and about the thickness of a strand of human hair. It is injected via a preloaded syringe through a small incision in the cornea (the clear part of the eye). Once implanted it creates a new outflow pathway from the anterior chamber to the subconjunctival space. The pliability allows it to conform to the ocular tissue which minimizes complications such as erosion or migration of the implant, while the tissue preserving approach means that future invasive surgeries are unimpeded. The XEN gel stent is considered a MicroInvasive Glaucoma Surgery (MIGS) that is capable of managing patients with very high pressures by forming a bleb.
Trabeculectomy
Trabeculectomy is a surgical treatment for glaucoma. It is an outpatient procedure, performed under topical anaesthetic with the option of light sedation. When the natural drainage pathways for the fluid inside of the eye are inadequate (causing increased intraocular pressure), this procedure will help to reduce intraocular pressure by creating a new drainage system. This new drainage system is a tunnel allowing the aqueous humour to drain from the anterior chamber to different compartment under the conjunctiva, which is the surface of the eye. After the procedure, a small dome called a filtering bleb will form on the conjunctiva, underneath the upper eyelid. This is where the fluid that is drained from the eye accumulates.
Tube Shunt Surgery
Tube shunts are also a form of traditional glaucoma surgery. This surgery is performed under local anesthesia with optional intravenous sedation. These devices create a new drainage system for the eye. Tube shunts lower intraocular pressure (IOP) by diverting aqueous from the anterior chamber into the reservoir, which is located in underneath the conjunctiva, around the back of the eye. The tube shunt is usually placed around the upper half of the eye, closer to the patient’s ear. The tube is covered with patch of donor sclera. This patch can be seen by others if you pull up your top lid and look down. Tube shunts are capable of treating glaucoma patients with high pressures.
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