Glaucoma surgery
Glaucoma is a chronic eye disease that damages the optic nerve and, if not treated in time, can lead to permanent vision loss. The primary cause of damage is most often raised intraocular pressure that disrupts the normal flow of aqueous humour. Glaucoma treatment includes medication therapy, laser procedures, and surgery.
When is the right time for surgery?
Surgery is used when drops and laser treatments fail to maintain intraocular pressure at the target level, or when a significant and rapid reduction in pressure is needed to stop disease progression.
At Milmedic Clinic, we apply three surgical approaches, depending on the type and stage of glaucoma and the individual characteristics of each patient.
High-Frequency Deep Sclerectomy (HFDS)
High-frequency deep sclerectomy (ab interno) is a modern surgical method of choice for open-angle glaucoma. Its main characteristics are innovation and minimal invasiveness. The procedure is straightforward and virtually painless, performed under local anaesthesia.
The procedure achieves a significant reduction in intraocular pressure (IOP). Using bipolar high-frequency radio energy, six points of deep sclerectomy are formed, significantly reducing resistance to aqueous outflow from the anterior chamber. The procedure can be successfully combined with cataract surgery (phacoemulsification) and can easily be applied as a standalone procedure.
As a rule, one procedure resolves raised intraocular pressure. In the rare cases where six deep sclerectomy openings are not sufficient to regulate pressure, the procedure can be repeated.
The procedure is particularly suitable for patients as it is performed as day-case surgery. European ten-year follow-up studies show that in approximately 80% of cases, stabilisation and normalisation of intraocular pressure is achieved without additional antiglaucoma therapy. Results are immediate, and intraocular pressure typically continues to decrease over the following six months.
Trabeculectomy (TTR)
Trabeculectomy (filtration surgery) is a surgical procedure used in the treatment of open-angle or narrow-angle glaucoma. It can be combined with medication or laser therapy and as a rule causes a significant drop in intraocular pressure.
The essence of the procedure is the surgical opening of a drainage channel through the sclera beneath the conjunctiva, through which excess aqueous humour can be drained and intraocular pressure kept under control. The filtration bleb is located superiorly at 12 o'clock under the upper eyelid and is completely unnoticeable. The operation is performed under local anaesthesia and is painless.
Implant Surgery
In circumstances where glaucoma is not adequately controlled by medication or laser procedures such as NdYAG laser iridotomy or selective laser trabeculoplasty (SLT), drainage implants are used. The more modern approach - also applied at Milmedic Clinic as the method of choice - is based on implanting the ExPRESS™ mini shunt for glaucomas not adequately controlled by other therapies. The valved device is placed under a scleral flap during a modified trabeculectomy procedure.
The procedure as a rule gives a very successful reduction in intraocular pressure, which is effectively stabilised long-term. The procedure is virtually painless, performed under local anaesthesia, and the patient goes home the same day. The ExPRESS™ mini shunt is made of premium materials, giving it virtually unlimited durability.
What to expect?
All three surgical methods are performed under local anaesthesia, and the patient goes home the same day. In the first few days, mild redness and discomfort are possible, which resolve with the prescribed therapy. Regular check-ups are essential to monitor intraocular pressure and respond promptly if adjustment of therapy is needed.
Glaucoma surgery at Milmedic Clinic is performed by an experienced team led by Prof. Dr Miroslav Vukosavljević, Prof. Dr Mirko Resan, and Dr David Simonovski.
Frequently asked questions
Does glaucoma surgery mean I no longer need drops?
The aim of surgery is to reduce or eliminate the need for drops, and in most patients it achieves this. Some patients, however, still need supplementary therapy - the doctor monitors pressure at check-ups and adjusts treatment as needed.
What happens if I don't have surgery?
Without adequate treatment, glaucoma continues to damage the optic nerve, which can lead to permanent vision loss. Surgery is recommended when medication is no longer sufficient to control pressure, and waiting in such situations increases the risk of irreversible vision damage.
Glaucoma may not be curable, but it can be stopped.
With timely surgery, pressure is stabilised and vision is preserved - our team is here to find the right solution for you.