New minimally invasive glaucoma surgeries
Seance of wednesday 21 june 2023 (Ophtalmologie - Les innovations technologiques et fondamentales qui repoussent les limites. Formation des jeunes chirurgiens)
DOI number : 10.26299/0tcq-2f98/emem.2023.23.02
Abstract
New minimally invasive glaucoma surgeries
Glaucoma is a degenerative optic neuropathy, a source of total and permanent blindness in the absence of treatment. The main cause is increased eye pressure due to an initial degeneration of the trabecular filter which regulates the evacuation of aqueous humor out of the eye. The treatment is essentially medical, possibly supplemented by laser techniques. But when this approach is insufficient or tolerance is poor, surgery is required. This is based above all on the evacuation of the aqueous humor out of the eye, crossing the trabecular meshwork, a portion of which is totally or partially removed. The aqueous humor thus released will diffuse into the sub-conjunctival space, forming a spongy tissue, called a filtration bleb, the result of a fragile balance between an aqueous humor reaching these tissues and the natural healing processes programmed to take place there. Trabeculectomy remains the reference surgery, but complications and especially long-term failures reduce its success. New so-called minimally invasive techniques have recently been developed and are in full expansion. Surgeries performed ab interno or ab externo, with or without a filtration bleb, targeting the trabecular meshwork with the aim of crossing the obstacle to the outflow of aqueous humor, drainage tubes or implants, or even opening systems of new escape routes to the posterior structures of the eye are thus developed. Some of these techniques are already well established in the therapeutic arsenal, and are even covered by health insurance, others are being evaluated. The purpose of this communication will be to establish the main principles, advantages and disadvantages of these new techniques which widen the fields of possibility to block, if possible definitively, the blinding degenerative process that constitutes glaucoma.
Glaucoma is a degenerative optic neuropathy, a source of total and permanent blindness in the absence of treatment. The main cause is increased eye pressure due to an initial degeneration of the trabecular filter which regulates the evacuation of aqueous humor out of the eye. The treatment is essentially medical, possibly supplemented by laser techniques. But when this approach is insufficient or tolerance is poor, surgery is required. This is based above all on the evacuation of the aqueous humor out of the eye, crossing the trabecular meshwork, a portion of which is totally or partially removed. The aqueous humor thus released will diffuse into the sub-conjunctival space, forming a spongy tissue, called a filtration bleb, the result of a fragile balance between an aqueous humor reaching these tissues and the natural healing processes programmed to take place there. Trabeculectomy remains the reference surgery, but complications and especially long-term failures reduce its success. New so-called minimally invasive techniques have recently been developed and are in full expansion. Surgeries performed ab interno or ab externo, with or without a filtration bleb, targeting the trabecular meshwork with the aim of crossing the obstacle to the outflow of aqueous humor, drainage tubes or implants, or even opening systems of new escape routes to the posterior structures of the eye are thus developed. Some of these techniques are already well established in the therapeutic arsenal, and are even covered by health insurance, others are being evaluated. The purpose of this communication will be to establish the main principles, advantages and disadvantages of these new techniques which widen the fields of possibility to block, if possible definitively, the blinding degenerative process that constitutes glaucoma.