Pioneering glaucoma operation to drain excess eye fluid will 'save sight of thousands of patients'

  • Affects 600,000 people in Britain, is the leading cause of irreversible sight loss
  • Triggered by fluid building up in the eye when drainage channels stop working
  • As a result, pressure builds inside the eye and over time damaging optic nerve 

A pioneering procedure could prevent thousands of Britons with the eye condition glaucoma from losing their sight. The disease, which affects at least 600,000 people in Britain, is the leading cause of irreversible sight loss.

It is triggered by fluid building up in the eye when tiny drainage channels stop working properly, for reasons that aren’t clear.

As a result, pressure builds up inside the eye and over time, this pressure damages the optic nerve that transmits visual images to the brain, leading to blindness if left untreated.

A pioneering procedure could prevent thousands of Britons with the eye condition glaucoma from losing their sight. The disease, which affects at least 600,000 people in Britain, is the leading cause of irreversible sight loss

A pioneering procedure could prevent thousands of Britons with the eye condition glaucoma from losing their sight. The disease, which affects at least 600,000 people in Britain, is the leading cause of irreversible sight loss

For decades, the main treatment has been lifelong eye drops to help both drain away the excess fluid or reduce the production of it. But some patients can struggle or forget to administer them daily, while others complain they make their eyes sore. Failure to use the drops means the condition can get worse, with devastating consequences.

Now, a new procedure can stop glaucoma in its tracks.

The technique combines inserting tiny stents into the eye to drain the excess fluid with laser treatment to stop the eye producing so much fluid.

It can be done at the same time as cataract surgery, meaning patients (many of whom have both cataracts and glaucoma) avoid two separate operations.

Traditional surgery for glaucoma, known as a trabeculectomy, is usually reserved for more advanced cases as it is more invasive.

The new technique is suitable for patients with mild to moderate glaucoma. Pioneered in Canada, it has been introduced to the UK by Mr Gok Ratnarajan, consultant ophthalmic and glaucoma surgeon at Queen Victoria Hospital NHS Foundation Trust in East Grinstead. He said: ‘While stents to drain fluid from the eye have been available for years, this is the first time we have combined them with laser to enhance the effects of the surgery. The aim is two-fold: to prevent glaucoma progression and reduce dependence on eye drops.’

It is triggered by fluid building up in the eye when tiny drainage channels stop working properly, for reasons that aren’t clear. As a result, pressure builds up inside the eye and over time, this pressure damages the optic nerve that transmits visual images to the brain, leading to blindness if left untreated

It is triggered by fluid building up in the eye when tiny drainage channels stop working properly, for reasons that aren’t clear. As a result, pressure builds up inside the eye and over time, this pressure damages the optic nerve that transmits visual images to the brain, leading to blindness if left untreated

He adds that regular eye tests are vital to ensure the disease is detected early, as most patients have no symptoms.

The new technique is done at the same time as cataract surgery, using numbing eye drops. It can also be performed as standalone surgery if the patient has previously had cataracts removed.

A 2mm incision is made through which two titanium stents – each 0.4mm in length – are inserted into a part of the eye called the trabecular meshwork. These drain fluid from the front of the eye into another area called Schlemm’s canal, a lymphatic-type vessel through which fluid is drained away by blood vessels.

The cataract is removed and the lens replaced with an artificial one. Finally, a laser is used to complete the glaucoma procedure, targeting the part of the eye called the ciliary processes that secrete the fluid, with the result that it doesn’t produce so much.

So far, 35 patients have had the procedure in the UK. ‘They all have lower pressure in their eye and many are on fewer, if any, glaucoma eye drops,’ says Mr Ratnarajan. ‘They are delighted with the initial results.’

Richard Ramsey, 70, from West Sussex, had the procedure six weeks ago. He had previously had the other eye operated on via the traditional, more invasive form of surgery. ‘The procedures are poles apart,’ he said.

‘After the first, I had to apply lots of eye drops each day. This time, I’d forgotten I’d had surgery by the next day.’

 

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