Glaucoma
Glaucoma, the world's leading cause of irreversible blindness, is a chronic, incurable condition in which the optic nerve is damaged. It is caused by an excessive accumulation of fluid between the cornea and the iris, resulting in excessive pressure that damages the optic nerve.
Symptoms: glaucoma can go undetected in its early stages, as it causes no pain or vision problems, hence the importance of regular screening. Left untreated, glaucoma leads to complete and irreversible blindness.
As the disease progresses - and it can affect only one or both eyes - peripheral and then central vision are impaired. The following symptoms may appear: intense pain in the eye, perception of a colored halo around light sources, visual decline or sudden blurred vision, reddening of the eyes, pupil dilation, headaches, nausea and vomiting.
Risk factors: family history of glaucoma, high myopia, intraocular inflammation, cardiovascular disease, long-term cortisone therapy.
Diagnosis: early diagnosis through a thorough examination can slow the progression of the disease and prevent blindness.
Our team of ophthalmologists is trained to diagnose glaucoma rapidly. Led by Dr. Eamon Sharkawim , a specialist in glaucoma and anterior segment surgery, he has pioneered multiple surgical techniques in this field and will suggest the most appropriate treatment for your pathology.
Medical treatment of glaucoma
Various anti-glaucoma medications (eye drops) are instilled into the eye on a daily basis. It's important to use them every day to keep eye pressure low and stable, and thus prevent the progression of glaucoma.
These drops are prescribed by the doctor; the therapy is personalized and adapted to each stage of the disease, as well as to the patient's tolerance. Over 30 different eye drops or combinations of treatments are available. These medications act by various mechanisms, either by reducing the production of aqueous humor inside the eye, or by increasing the outflow through the trabeculum or uveoscleral pathway, thereby lowering intraocular pressure.
Laser treatment of glaucoma
- SLT, Selective Laser Trabeculoplasty
This is a low-energy laser treatment designed to stimulate the eye's drainage system, the trabeculum. It presents few risks, can be performed during a pain-free consultation, and often helps reduce intraocular pressure and even stop medication.
How does the SLT work?
The Laser stimulates a natural healing process in the body. Short, low-energy pulses target the melanin, or pigment, in specific cells of the eye. In response, the healing mechanism rebuilds these cells. This cell regeneration process improves drainage and helps reduce intraocular pressure.
Is SLT painful?
No, SLT is not painful and does not cause any worrying side effects.
What happens during the procedure?
SLT treatment takes just a few minutes. Prior to treatment, your ophthalmologist will administer drops to prepare your eye and create a moderate anesthetic. Treatment then takes place through a slit lamp, a specially adapted microscope.
Who can benefit from a SLT?
You're a good candidate for an SLT if you fit into one of the following categories, :
- You have open-angle glaucoma, pseudoexfoliation or pigmentary glaucoma (ask your ophthalmologist if you're not sure).
- You are intolerant to anti-glaucoma medications or have difficulty taking them as prescribed.
- You have started an anti-glaucoma treatment and would like to combine it with SLT.
- It is difficult for you to ensure regular treatment follow-up for financial, transportation or other reasons.
- Peripheral Iridotomy under YAG laser
This laser is used to create a micro-perforation of the iris, enabling the iridocorneal angle to be widened in patients with narrow-angle or closed-angle glaucoma. This can reduce the risk of future glaucoma and prevent acute glaucoma attacks.
- Peripheral Iridoplasty under ARGON Laser
This technique is used when the angles remain narrow despite a peripheral iridotomy. It helps to reduce the size of the peripheral iris by moving it away from the trabeculum, to prevent contact with it, since contact is the primary cause of damage to the trabeculum.
Surgical treatments
progrThis procedure is used in cases of advanced glaucomaTrabecular pathway
The trabeculum is the eye's main drainage channel. It is a "natural" or physiological 360-degree channel that surrounds the iris tips. Surgical treatments aim to improve the reduced capacity of this drainage function. Depending on the patient's specific needs, we may consider either the implantation of a stent in part of the trabeculum (iStent), dilatation of the entire canal (canaloplasty ab interno), surgical opening of the inner canal wall in more advanced cases (GATT), or a combination of these micro-invasive procedures. These new operations are grouped together under the acronym MIGS, for "Microinvasive Glaucoma Surgery Techniques".
- AB INTERNO CANOPLASTY
This procedure involves introducing a 250-micron microcatheter, illuminated by an optical fiber, into the trabecular system, enabling 360° treatment of the entire drainage system. This device passes through a precise incision in the cornea, then through a small opening in the trabeculum. Thanks to this micro-catheter, a controlled injection of viscoelastic gel is made into the canal, restoring the functioning of the defective drainage system and reducing intraocular pressure, without the need for an implant in the eye. The eye's natural anatomy is thus preserved.
The trabeculum can function again, reducing pressure and the need for eye drops. This procedure can be combined with cataract surgery.
- GATT - GONIOSCOPY ASSISTED TRANSLUMINAL TRABECULOTOMY
This procedure, similar to ab interno canaloplasty, involves opening the inner wall of the trabeculum or the entrance to the system. This removes the main resistance in the drainage canal, resulting in a greater drop in intraocular pressure. This procedure is used in cases of advanced glaucoma.
It can be combined with cataract surgery or performed independently, maintaining the eye's natural anatomy without the need for a permanent implant or stent in the eye.
Dr. Sharkawi was the first surgeon in Switzerland to perform this procedure, and the first in Europe to perform it on children. He is also one of the world's most experienced surgeons in this field, and trains other surgeons in Europe, the USA and Africa.
- I-STENT (TRABECULAR BYPASS)
The iStent involves inserting a 1mm titanium microstent into the trabeculum, which acts as a small tube diverting fluids to the deeper layers of the drainage system, bypassing the area of major resistance. This lowers intraocular pressure and reduces the need for drops.
The iStent can be implanted either alone or in combination with cataract surgery. It is a micro-invasive procedure that does not distort the eye's anatomy and has a very high safety profile.
Subconjunctival route
This is the standard drainage route used by glaucoma surgeons for many years. A trabeculotomy is performed when the trabecular drainage system is non-functional.
- ADJUSTABLE TRABECULECTOMY
Aqueous humor is diverted directly into the subconjunctival space from the anterior chamber, creating a small opening in the sclera (white of the eye). Modern techniques use adjustable sutures for individualized drainage. Suture tension can be adjusted postoperatively to achieve adequate intraocular pressure in gradual steps.
This approach reduces the number of complications linked to hypotonia (low pressure) associated with older techniques.
Anti-scarring medication is used to ensure lasting pressure reduction.
- PERSERFLO IMPLANT
The Perserflo implant follows a similar procedure to trabeculectomy, withthe addition of a drainage system at the mid-upper subconjunctival level. It diverts the aqueous humor directly, reducing operating time and accelerating vision recovery. The implant directs aqueous fluid to the posterior conjunctiva, producing a more stable filtration bead and reducing the risk of infection and discomfort.
- XEN IMPLANT
The Xen implant uses a procedure similar to trabeculectomy, but with the addition of a stent to divert aqueous humor directly into the subconjunctival space. This reduces operating time and facilitates recovery. This approach is suitable for all stages of the disease, and a discussion with the surgeon helps to assess the best option.
BAERVELDT TUBE
These drainage tubes are used when trabeculectomy or other subconjunctival procedures are deemed to be at high risk of failure or have already failed. This is a larger implant that diverts fluid to the posterior conjunctiva of the eye. Thanks to modern techniques, this procedure is extremely safe.
Dr. Sharkawi has introduced several new, published surgical techniques that make operations safer and more effective than traditional techniques. He is the most experienced surgeon in Baerveldt tube implantation for complex glaucoma in adults and pediatric cases.