Type of Surgery
Information
Last updated: 02/17/2009
Nonpenetrating deep sclerectomy
There are two surgical alternatives to sclerostomy that are called nonpenetrating deep sclerectomies because they do not involve entering the anterior chamber of the eye. The first alternative, viscocanalostomy,...
is a procedure that involves creating a window in Descemet's membrane (a layer of tissue in the cornea) to allow aqueous humor to leave the anterior chamber; and injecting a viscoelastic substance into Schlemm's canal, which is the main pathway for aqueous humor to leave the eye. The viscoelastic helps to keep the canal from scarring shut following surgery.
The second type of nonpenetrating surgery involves implanting a device called the Aquaflow® collagen wick about 0.8 in (2 cm) long under the sclera. The wick keeps open a space created by the surgeon to allow drainage of the aqueous humor. The wick is made of a material that is absorbed by the body within six to nine months, but the drainage pathway remains open after the wick is absorbed. The Aquaflow wick was approved by the Food and Drug Administration (FDA) in July 2001.
Both types of nonpenetrating deep sclerectomies allow patients to recover faster, with fewer complications than traditional sclerostomies. Their drawbacks include a lower success rate and the need for additional procedures to control the patient's IOP. Viscocanalostomy in particular is not as effective in reducing IOP levels as traditional filtering surgery.
Complementary and alternative (CAM) approaches
Bilberry (European blueberry) extract has been recommended as improving night vision; it was given to RAF pilots during World War II for this reason. There is evidence that 80–160 mg of bilberry extract taken three times a day does improve night vision temporarily. The plant does not have any serious side effects, but it should not be used in place of regular eye examinations or other treatments for glaucoma.
People who support the medicinal use of marijuana have argued that cannabinoids, the active chemical compounds found in the plant, lower intraocular pressure in patients with glaucoma. According to the Glaucoma Research Foundation, however, very high doses of marijuana are required to produce any significant effect on IOP. A Canadian researcher has concluded that the effects of cannabinoids on IOP "....are not sufficiently strong, long lasting or reliable to provide a valid basis for therapeutic use [of marijuana]."
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Other Information
A sclerostomy is a procedure in which the surgeon makes a small opening in the outer covering of the eye-ball to reduce intraocular pressure (IOP) in patients with open-angle glaucoma. It is classified as a type of glaucoma filtering surgery. The name of the surgery comes from the Greek word for "hard," which describes the tough white outer coat of the eyeball, and the Greek word for "cutting" or "incision."
Purpose
Sclerostomies are usually performed to reduce IOP in open-angle glaucoma patients who have not been helped by less invasive forms of treatment, specifically medications and laser surgery. In some cases—most commonly patients who are rapidly losing their vision or who cannot tolerate glaucoma medications—an ophthalmologist (eye specialist) may recommend a sclerostomy without trying other forms of treatment first.
Other Information
Approximately 56% of all patients achieve results of 20/20 or better and over 90% achieve 20/40 or better (which is good enough to drive without corrective lenses in most regions).1 Those with moderate to high myopia (greater than 7 diopters) have a lesser chance of achieving that result. As technique and technology improve, the results continue to improve.
From: Eye Surgery Education Council
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