Minimally Invasive Glaucoma Surgery – A new treatment
GLAUCOMA is an eye disease that occur predominantly in older people and is the leading cause of irreversible blindness worldwide. It is called the ‘silent thief of sight’ because high eye pressure slowly damages your optic nerves, which is the pathway that communicates vision between your eyes and your brain.
The damage occur so slowly that the patient does not complain of any eye symptoms until it is too late. An ophthalmologist can diagnose glaucoma by measuring your eye pressure, examining your optic nerve and performing visual field testing.
Traditionally, patients with glaucoma are put on multiple antiglaucoma eye drops in order to lower their eye pressure and hence protect their optic nerve from further damage. Long term usage of these anti-glaucoma eye drops brought about side effects such as eye irritation and dryness besides causing a burden to the patients in terms of the strict application regime as well as financially. In short, this treatment actually compromises the quality of life of the glaucoma patients.
The iStent? G1 is known to be the smallest medical device implant (0.5 mm by 1.0 mm) approved by the United States Food and Drug Administration. The iStent inject (commonly called iStent G2 Premium) is even smaller at 0.2 mm by 0.4 mm.
Trabecular microbypass with iStent implants is an entirely new, safe and effective treatment option for open-angle glaucoma patients wherein the device is implanted into the eye’s drainage canal during cataract surgery to restore the natural pathway for fluid outflow. This in turn reduces the pressure in the eye and possibly reduce patient’s dependency on the anti-glaucoma eye drops.
Patients with mild to moderate open-angle glaucoma can benefit from iStent and its second-generation iStent inject Trabecular Micro-Bypass device.
The iStent implantation surgery is minimally invasive. It can be done as a standalone procedure under local anaesthesia through a 2 mm incision wound for the implantation.
When it is performed together with cataract surgery, it is implanted through the same incision as per the cataract surgery. It is a very safe procedure with minimal or negligible risks, a very fast recovery time and most importantly patient does not experience any post operation eye pain or discomfort at all.
This is in contrast to the traditional glaucoma surgery whereby the operation itself is associated with higher risks of complications, tedious and frequent post operative follow ups. Furthermore patients will experience a lot of eye redness, discomfort and pain during the recovery period from the traditional glaucoma surgery, which is virtually non-existent in iStent surgery.
Numerous studies worldwide have proved that the iStent G1 and iStent inject G2 bring significant reductions in eye pressure, and this pressure reduction is sustainable even after years of implantation. It is a good option for patients who are not compliant or are suffering side effects from glaucoma eye medications or who need additional lowering of eye pressure because other medication/laser treatments have failed.
iStent surgery requires a high precision implantation technique by qualified surgeons. Dr. Sim Pek Eng, the eye specialist at Gleneagles Kota Kinabalu, is the first surgeon in East Malaysia to perform trabecular microbypass surgery with iStent for the treatment of mild to moderate open-angle glaucoma.
Her centre is currently the only site that provides iStent surgeries for patients with glaucoma in Sabah. Since she started performing this procedure in March last year, she is able to reduce the eye pressure and therefore take most of her patients off antiglaucoma medications after the procedure.
Therefore, if you are having glaucoma and are going for cataract surgery, you might want to enquire further about this procedure from your surgeon.
About the writer: Dr Sim Pek Eng is Consultant Ophthalmologist & Refractive Surgeon with Gleneagles Kota Kinabalu.