Glaucoma is a disease that affects over 6 million people worldwide and is the leading cause of blindness, according to MedicineNet.com's glaucoma report. Advances in glaucoma treatment have saved many patients from vision loss, but refractory glaucoma is more stubborn and is therefore more difficult to treat. Several treatment options are available.
Identification
The term "refractory glaucoma" describes a case of glaucoma that does not respond to typical drugs and treatments. In most cases, eye drops or oral medications are prescribed to lower eye pressure (intraocular pressure, IOP) and are found to be ineffective for patients with refractory glaucoma.
Function of Treatment
Ocular hypertension, the term for high IOP, is threatening to the optic nerve, which is responsible for vision, and can result in vision loss if damaged. To lower IOP to normal levels, the built up eye fluids require reduction through drainage.Refractory glaucoma treatments effectively reduce this eye fluid that causes ocular hypertension.
Implants
A French study, published in the U.S. National Library of Medicine, showed that implants are a treatment option for refractory glaucoma patients. Implants are aesthetic drainage systems that are attached to the surface of the eye to allow the fluids to flow outwards, thereby reducing eye pressure.
Trabeculectomy and Mitomycin C
Trabeculectomy is a procedure that employs laser technology to create a new channel in the eye through which to drain fluids, and therefore lower eye pressure. Mitomycin C is is a drug (antimetabolite) used during the first stages of trabeculectomy surgery to enhance performance. A study on published on the Cochrane Collaboration found this combination effective for lowering IOP, though there is risk of cataract development.
Viscocanalostomy
AllAboutVision.com's report, "Glaucoma Surgery," by Marilyn Haddrill, discusses a new surgical procedure called a viscocanalostomy. During this procedure, an opening is created through which to insert a pliable gel material, called viscoelastic, which helps to create adequate space for drainage and relieves eye pressure. This type of treatment is considered a nonpenetrating glaucoma surgery.
Alternative Laser Treatments
Advances in laser technology have made a tremendous impact on the treatment of refractory glaucoma since laser energy, light, and heat are able to penetrate the eye tissue. This laser technology dissolves excess fluids, creates new drainage passageways, and in severe cases, dissolve fluid-producing cells. Types of laser treatments include trabeculectomy, trabeculotomy, goniotomy (for children), and iridotomy.
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