Glaucoma, the leading cause of irreversible blindness in the world, is a chronic incurable condition in which the optic nerve is damaged. It results in the presence of too much fluid between the cornea and the iris and too much pressure that crushes the optic nerve.
Symptoms: Glaucoma can go unnoticed in its early stages because it causes no pain or vision problems, hence the importance of regular screening. Without treatment, glaucoma leads to complete and irreversible blindness.
Once the disease progresses - it can affect only one of the two eyes - the peripheral vision and then the central vision are altered and the following symptoms can appear: a very sharp pain in the eye, the perception of a colored halo around the light sources, a visual decline or a sudden blurred vision, the reddening of the eyes, a dilation of the pupil, headaches, nausea, vomiting.
Risk factors: family history of glaucoma, high myopia, intraocular inflammations, cardiovascular diseases, prolonged cortisone treatment.
Diagnosis: an early diagnosis through a thorough examination can slow down the evolution of the disease and prevent blindness
Our team of ophthalmologists is trained to diagnose glaucoma as quickly as possible. Led by Dr. Eamon Sharkawi - a specialist in glaucoma and anterior segment surgery - he has pioneered multiple surgical techniques in the field of glaucoma and will therefore be able to offer you the most appropriate treatment for your condition.
Medical treatment of glaucoma
Various anti-glaucoma medications (eye drops) are instilled into the eye daily. It is important to use them every day in order to maintain a stable low pressure and to avoid progression of glaucoma.
These drops are prescribed by the doctor, the treatment is personalised and adapted to each stage of the disease and to the patient's tolerance. More than 30 different eye drops or combinations of treatments are available. These medications work by different mechanisms, either by reducing the production of aqueous humour inside the eye or by increasing the outflow through the trabeculum or the uveoscleral pathway, thus decreasing the 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 is low-risk and painless, and can be performed during the consultation. It often results in a reduction in intraocular pressure or even in the discontinuation of 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 will rebuild these cells. This process of cell regeneration increases drainage and contributes to the lowering of intraocular pressure.
Is SLT painful?
No, SLT is not painful and there are no side effects to worry about.
What happens during the procedure?
SLT treatment takes only a few minutes. Before the treatment, your ophthalmologist will give you drops to prepare your eye and give you a mild anaesthetic. The treatment can then be started through a slit lamp, a specially adapted microscope.
Who can benefit from a SLT?
If you fit one of the following categories, you are a good candidate for an SLT:
- you have open angle glaucoma, pseudoexfoliation or pigmentary glaucoma (if you are not sure, ask your ophthalmologist)
- you are intolerant to anti-glaucoma medication or have difficulty taking it as prescribed.
- you have started a therapeutic anti-glaucoma treatment and want to combine it with SLT.
- it is difficult for you to ensure regular follow-up treatment for financial, transportation or other reasons.
- Peripheral Iridotomy under YAG laser
This laser is used to create a micro-perforation of the iris. This widens the iridocorneal angle in patients with narrow angle or closed angle glaucoma and subsequently reduces the risk of future glaucoma and prevents 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 and preventing contact with the trabeculum, as this is the primary cause of trabecular damage.
The trabeculum is the main drainage pathway in the eye. It is a 360 degree "natural or physiological" channel encircling the iris tips. Surgical treatments consist in increasing the reduced capacity of the drainage function. Depending on the specific needs of the patient, we may consider either the implantation of a stent in a part of the trabeculum (iStent), a dilatation of the entire canal (canaloplasty ab interno), a surgical opening of the inner wall of the canal in the case of more advanced disease (GATT), or a combination of these micro-invasive procedures. These new operations are grouped under the acronym MIGS for "Microinvasive Glaucoma Surgery Techniques".
- AB INTERNO CANOPLASTY
This is a procedure in which a 250-micron microcatheter illuminated by a fibre optic is introduced into the trabecular system allowing a 360° treatment of the entire drainage system. This device is passed through a precise incision in the cornea and then through a small opening in the trabeculum. With this microcatheter, a controlled injection of a viscoelastic gel into the canal is performed, which allows the defective drainage system to be reactivated and the intraocular pressure to be reduced, without the need for an implant in the eye. The natural anatomy of the eye is preserved.
The trabeculum can function again, reducing pressure and the need for eye drops. This procedure can be combined with cataract surgery.
- GATT PROCEDURE( GONIOSCOPY-ASSISTED TRANSLUMINALTRABECULECTOMY )
This is a procedure similar to that of an ab interno canaloplasty, where the inner wall of the trabeculum or the entrance to the system is opened. In this way, the greatest resistance of the drainage channel is removed. This results in a much higher pressure drop. This procedure is performed in cases of advanced disease.
This procedure can be combined with cataract surgery or performed independently. It maintains the natural anatomy of the eye 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 one of the most experienced surgeons in the world with this technique. He teaches the procedure to other surgeons in Europe, the USA and Africa.
- I-STENT (TRABECULAR BYPASS)
Insertion of a 1mm Titanium micro stent into the trabeculum which acts as a tube diverting fluids into the deeper layers of the drainage system and bypasses the major site of resistance contributing to the pressure drop as well as the number of useful drops.
The iStent can either be implanted alone or in combination with cataract surgery. It is a minimally invasive procedure that does not distort the anatomy of the eye and has an extremely safe profile.
This is a standard drainage route that has been used for many years by glaucoma surgeons. A trabeculotomy is performed when the trabecular drainage system is non-functional.
- ADJUSTABLE TRABECULECTOMY
The aqueous humour is diverted directly into the subconjunctival space from the anterior chamber by creating a small opening in the sclera (white of the eye). Modern techniques use adjustable sutures to allow individualised drainage. The tension of the sutures can be adjusted in the postoperative period by the surgeon in the office, to achieve an adequate intraocular pressure in gradual steps.
This approach reduces the number of hypotonic (low pressure) complications associated with older techniques.
Anti-scarring medication is used to achieve long-term pressure reduction.
- PERSERFLO IMPLANT
The Perserflo implant uses a procedure similar to trabeculectomy , with the addition of a drainage system at the mid-upper subconjunctival level to divert the aqueous humor directly, reducing operating time and vision recovery time. This approach is less invasive, as it requires no incision in the sclera or subconjunctiva. A discussion with the surgeon is then useful to assess the best individual approach.
- XEN IMPLANT
The Xen implant uses a procedure similar to trabeculotomy with the addition of a stent to divert the aqueous humour directly into the subconjunctival space, reducing operative time and time to recovery of vision. This approach is possible at all stages of the disease and a discussion with the surgeon is useful to assess the best solution.
- BAERVELDT TUBE
These drainage tubes are used when trabeculotomy or other subconjunctival procedures are deemed to be at high risk of failure or have already failed. It is a larger implant that diverts fluid into the posterior conjunctiva of the eye. Thanks to modern techniques, this is a very safe procedure.
Dr. Sharkawi has introduced several new, published, surgical techniques, which make these operations safer and more effective compared to traditional techniques. His expertise in Baerveldt tube implantations for complex cases in adults and in pediatric glaucoma cases is unparalleled.