Glaucoma treatment: the medical-surgical process

Glaucoma treatment aims to lower eye pressure to reach a target pressure.
Target pressure is the pressure under treatment that prevents progression or the appearance of visual field deficits.
A 20% reduction in initial pressure is considered sufficient in most cases.
A 25% reduction in pressure reduces the risk of progression by 45%.
In the case of advanced glaucoma, the pressure must be less than 18 mm Hg and in some cases lower.
Any diagnosed glaucoma must be treated either with eye drops, or with Laser treatment, or with surgery.

Medical treatment

Almost always in the form of eye drops which must be instilled regularly for better effectiveness.

The choice of eye drops prescribed as first-line treatment depends on its tolerance, its efficacy and its contraindications and adverse effects.

• Certains agissent en baissant la sécrétion de l’humeur aqueuse de l’œil :
  • Collyres bêta bloquants (Timoptol, Carteol, Betoptic…)
    Mais il faudra au préalable s’assurer de l’absence de contre-indications (maladie cardiaque de la conduction, asthme, diabète insulinodépendant etc.…).
    Ils sont le plus souvent prescrits en première intention à raison d’une fois ou deux par jour.
  • Certains collyres sont des inhibiteurs de l’anhydrase carbonique dorzolamide (Trusopt, Azopt)
  • Citons également les collyres alpha 2-agoniste (Alphagan, Lumigan …)
• D’autres collyres agissent au contraire en augmentant l’élimination de l’humeur aqueuse :
  • Collyres Adrénaline et dérivés (Epinephrine)
  • Collyres Prostaglandine (Xalatan, Travatan) très prescrits.

These treatments can cause a change in eye color, eyelash changes and, like all other eye drops, eye irritation upon instillation or even allergies.

Finally, let us add that each class can be combined with another in the same bottle in order to increase effectiveness:

• Beta blocker and pilocarpine (CARPILO, TIMPILO),
• Anhydrase inhibitor and adrenergic antagonist (COSOPT),
• Prostaglandin and beta-blocker (XALACOM).

In practice, beta-blocker eye drops are often prescribed as a first-line treatment, but some people also prefer to use a prostaglandin because of its lower risk of side effects.

Glaucoma Treatment: Surgical Mode

Glaucoma treatment by surgery, although rarer, remains the last resort when medical or laser treatment has failed (increased pressure, worsening of the visual field, treatment not followed).

When treating glaucoma by surgery, the operation is performed either on an outpatient basis or after a short hospitalization.

It involves trabeculectomy or deep sclerectomy.

Both techniques create an additional passageway for the evacuation of aqueous humor.

Unlike cataract surgery, during which vision returns quickly, glaucoma surgery results in poor vision in the days that follow, which lasts for a few days.

Furthermore, it does not repair damage to the optic nerve that has been permanently destroyed.

In expert hands, the success rate of glaucoma surgery on previously unoperated eyes is approximately 90% at 2 years.