Patient's question:
If it is confirmed to be glaucoma, how should it be treated..Doctor's answer:
Glaucoma, as an eye disease with a very high rate of blindness, has become a focal point of attention for many ophthalmology experts. Different treatment methods are chosen based on the different types of glaucoma. Experts from Kunming Pu Rui Eye Hospital have summarized the treatment methods for glaucoma as follows:1. Primary open-angle glaucoma is primarily treated with medication to inhibit aqueous humor production, control intraocular pressure, widen the trabecular meshwork spaces, and promote aqueous humor drainage. For patients who cannot control intraocular pressure or tolerate medication through monotherapy or combination therapy, other medications can be used to increase aqueous humor drainage. If drug treatment is ineffective or the results are unsatisfactory, laser trabeculoplasty should be adopted, often supplemented with medication after surgery.
2. Primary angle-closure glaucoma is treated with surgery as the first choice upon diagnosis. Drug treatment is limited to preparing for surgery, controlling poor intraocular pressure postoperatively, or when surgical risks are very high. Currently, many hospitals can perform laser peripheral iridotomy, allowing the majority of patients to avoid root incision surgery. However, if conditions are not available, root incision surgery should still be performed as early as possible.
3. Secondary glaucoma has many types and varies greatly in treatment. The key is to treat the primary disease and glaucoma simultaneously. The treatment for secondary open-angle glaucoma is roughly the same as that for primary open-angle glaucoma. The management of malignant glaucoma requires special caution. When conditions permit, photocoagulation of the entire retina is the first choice for neovascular glaucoma. In advanced glaucoma with vision loss, severe pain, and bullous keratitis, ciliary body freezing or enucleation of the eye may be considered.
4. During acute episodes, patients have high intraocular pressure and should first be treated with medication to lower it. If conditions allow, laser peripheral iridotomy, laser peripheral iridoplasty, or laser pupiloplasty can be performed to eliminate pupillary block. Before surgery, intraocular pressure must be reduced to normal. After controlling intraocular pressure, the anterior chamber angle should be examined. If more than 50% of the anterior chamber angle is open, root incision surgery may still be chosen. Otherwise, filtration surgery such as trabeculectomy should be selected. If intraocular pressure control is poor postoperatively, medication should be supplemented.
5. Congenital glaucoma should be surgically treated as early as possible. Common surgeries include anterior chamber trephination, trabecular trephination, and trabeculectomy, which can also be used in combination. Medication can be supplemented before and after surgery to control intraocular pressure, avoiding the use of mydriatics.
6. If intraocular pressure control is still unsatisfactory after the above treatments, surgical treatment must be chosen. Common surgeries include trabeculectomy or other filtration surgeries. For patients with high intraocular pressure before surgery, oral medication to lower intraocular pressure can be taken to reduce it as much as possible to normal levels.