Glaucoma: Should Bleb Surgery Be Tried Before Shunt Surgery?
MAR 03, 2014
Question:
I am a 54-year-old woman with a strong family history of glaucoma (a disease that increases pressure in the eye, damaging the optic nerve). I have been treated for glaucoma for approximately 15 years. I have primarily used a combination of Xalatan and Cosopt during this time. I've also used Alphagan with good results but developed an allergy. In the last two years, I am starting to have significant vision loss. My doctor has performed laser surgery (a glaucoma treatment that applies laser to the eye to stimulate drainage and relieve pressure), but my pressures are still usually 15-17 in both eyes. We are starting to discuss "bleb" surgery (a surgery for glaucoma that creates a reservoir, or "bleb," to help drain excess fluid from the eye). I have also read a little about shunt surgery (a surgery for glaucoma that drains excess fluid by placing a small tube, or shunt, in the eye). Why would "bleb" surgery be the first course for surgery over shunt surgery?
Answer:
There are three main categories of treatment for glaucoma: medications, laser treatment, and surgery. It appears that your ophthalmologist has followed a very common approach in glaucoma management; i.e., he has initially tried a combination of medications and laser treatments. Unfortunately, in some patients, despite our best efforts, the combination of medications and laser treatment may prove inadequate to control glaucoma. At that point, there are various surgical options that are available. If surgery is intended strictly for managing the glaucoma, then both filtering surgery, which typically results in a filtering bleb, is an option, as is placement of a shunt which does not typically result in the formation of a bleb. Each eye in each situation is unique, and patients are encouraged to discuss the various options available to them to determine which of these options would be ideal for their situation. Unfortunately, though most patients do well, there are potential risks and complications with all types of surgery. It is important to discuss these with your surgeon to make sure all of your questions are answered so you can make the right decision.
One other consideration that can influence what surgical procedure is undertaken is if there is also a cataract present. If there is also a cataract present at the time of the need for glaucoma surgery, then one might consider a combined procedure, which is cataract surgery performed along with a glaucoma procedure. In that circumstance, additional glaucoma surgery options arise, and it would be worthwhile to discuss this with your ophthalmologist as well.