Type of Surgery
Information
Last updated: 02/17/2009
Most sclerostomies are performed as outpatient procedures under local anesthesia. In some cases the patient may be given an intravenous sedative to help him or her relax before the procedure.
Conventional sclerostomy
After...
the patient has been sedated, the surgeon injects a local anesthetic into the area around the eye as well as a medication to prevent eye movement. Using very small instruments with the help of a microscope, the surgeon makes a tiny hole in the sclera as a passageway for aqueous humor. Some surgeons use an erbium YAG laser to create the hole. Most surgeons apply an antimetabolite drug during the procedure to minimize the risk that the new drainage channel will be closed by tissue regrowth. The most common antimetabolites that are used are mitomycin and 5-fluouracil.
After the surgery, the aqueous humor begins to flow through the sclerostomy hole and forms a small blister-like structure on the upper surface of the eye. This structure is known as a bleb or filtration bleb, and is covered by the eyelid. The bleb allows the aqueous humor to leave the eye in a controlled fashion.
Enzymatic sclerostomy
A newer technique that was first described in 2002 is enzymatic sclerostomy, which was developed at the Weizmann Institute of Science in Israel. In enzymatic sclerostomy, the surgeon applies an enzyme called collagenase to the eye to increase the release of aqueous humor. The collagenase is applied through an applicator that is attached to the eye with tissue glue for 22–24 hours and then removed. According to the researchers, the procedure reduced the intraocular pressure in all patients immediately following the procedure and in 80% of the subjects at one-year follow-up. None of the patients developed systemic complications. Enzymatic sclerostomy is considered experimental as of mid-2003.
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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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