How glaucoma surgery is done

  Glaucoma is a blinding eye disease that requires prompt management or it can lead to complete loss of vision. Depending on the type of glaucoma, the surgical procedure varies. The main surgical procedures commonly used are intra-atrial drainage surgery, external drainage (filtration) surgery, and ciliary body disruption surgery.  Intra-atrial drainage surgery: The main goal is to release the pupillary block, communicate with the anterior and posterior atrial aqueous humor, and release the pressure difference in the eye. The procedure is a peripheral iridotomy, in which a portion of the iris tissue is cut in the upper periphery to create a triangular incision, thus bridging the anterior and posterior chambers, and can be used to treat patients in the preclinical or remission phase of primary angle-closure glaucoma. This procedure is now less commonly performed and has been replaced by laser peripheral iridotomy.  Filtering surgery: Filtering surgery is commonly performed with trabeculectomy. There are two types of conjunctival flaps in common use, a high conjunctival flap, which is based on the corneal limbus, and a low conjunctival flap, which is based on the fornix; afterwards, the corresponding area of the peripheral iris is resected and a 1*3 mm trabecular tissue is removed to drain the atrial fluid under the conjunctival flap, thus reducing the intraocular pressure. Atrial fluid drainage valve implantation is also an effective filtration procedure. The procedure of making a conjunctival flap is the same as trabeculectomy, and then, one end of the silicone tube of the drainage valve is inserted into the anterior chamber to drain the atrial fluid under the conjunctival flap.  Destructive ciliary body surgery: This includes ciliary body condensation, ciliary body photocoagulation, which destroys the ciliary body with liquid nitrogen or laser to reach the effect of reducing atrial aqueous secretion and thus the intraocular pressure. It can be used to treat patients with advanced glaucoma, especially those who have difficulty controlling IOP with other methods and whose vision has been lost.  In summary, surgical treatment of glaucoma should be based on the specific type of lesion. The current conventional surgical procedures include laser peripheral iridectomy, trabeculectomy, drainage valve implantation, and ciliary body condensation.