Green Star – treatment

Green Star: Treatment must be fast and effective

The longer a green cataract, the faster the disease progresses. Early detection of glaucoma is therefore important for the success of treatment. The goal of glaucoma treatment is to permanently lower the pressure in the eyeball below the critical value so that enough blood can flow back to the cells of the retina and the optic nerve.

This “critical intraocular pressure” is individually different and depends on the mean pressure at which the blood circulates in the blood vessels of the eyeball (perfusion pressure). It is important that the pressure in the eyeball is well below the perfusion pressure, so that the blood flow is not opposed too much resistance. Ophthalmologists call the target value for intraocular pressure also “target pressure.”

Determining the individual target pressure, especially at the beginning of a glaucoma treatment, requires close monitoring of the intraocular pressure, the blood pressure of the patient as well as the blood supply to the retina and optic nerve head (optic nerve papilla). The ophthalmologist checks the treatment success. For this he uses in principle the same procedures as for the diagnosis of glaucoma. Control is also important because glaucoma can worsen over time. In this case, the therapy needs to be adjusted. Whether this is possible with medication, or requires a glaucoma operation, depends on the cause, but also on the course of the disease.

Green Star: treatment with drugs

Not all forms of glaucoma can be treated satisfactorily with medication. However, drug therapy is often sufficient for the most common form, open-angle glaucoma. Older people are affected by this form, in which deposits (plaques) form in the chamber angle of the eye, which hinder the outflow of aqueous humor.

For the treatment of the green star with drugs, there are basically two starting points. On the one hand, agents can be used which restrict the formation of aqueous humor. On the other hand, substances used to improve the outflow of aqueous humor are used for glaucoma treatment. Glaucoma drugs are available as tablets, drops, eye drops or injectable solutions – the following groups of drugs are suitable for glaucoma therapy:

Beta blockers are widely used to treat the green catfish – they slow down the production of aqueous humor. In the case of bronchial asthma and certain heart diseases (eg heart failure or certain forms of cardiac arrhythmias), beta-blockers should not be used.

carbonic anhydrase inhibitors also slow down the production of aqueous humor. In an acute glaucoma attack, the agent can also be injected directly into the vein, so it works faster. Known active ingredients in eye drops are, for example, Dorzolamide and Brinzolamide are active ingredients of eye drops.

prostaglandins reduce intraocular pressure by improving the outflow of aqueous humor. A side effect of prostaglandins is that the color of the iris (iris) can become darker.

sympathomimetic counteract the glaucoma by lowering the production of aqueous humor.

parasympathomimetics constrict the pupil (miosis), thereby widening the angle of the chamber and facilitating the outflow of aqueous humor. Unpleasant side effect: The narrowing of the pupil, especially older people are limited in their eyesight.

In some cases of glaucoma, the doctor also uses different preparations in combination. Thus, for example, a reduced production of aqueous humor and a better outflow of the same can complement one another to a sufficient effect. The choice of drugs, their dosage and possible combinations of the doctor agrees on the individual glaucoma-type. It is important that the doctor and the glaucoma patient work well together and that the patient consistently complies with the therapy.

Green Star: Operation

If glaucoma medication can not adequately and reliably reduce intraocular pressure, surgery will be required. Sometimes the two glaucoma therapies can complement each other. For example, in the case of a glaucoma attack, medicines are first used for acute pressure relief, and the eye is then operated on. In the early childhood form of the green star (primary congenital glaucoma) a glaucoma operation is performed as early as possible. The following methods are used:

Laser trabeculoplasty

The sieve-like braid in the chamber angle (trabecula) is bombarded with laser beams, which improves the drainage. The method is mainly used in patients with open-angle glaucoma. Ideally, the pressure in the eye can thus be lowered by about eight millimeters of mercury (mmHg). The procedure is performed under local anesthesia and the patient can go home immediately after treatment. The effect of laser therapy is often not lasting in a green star.

Trabekelektomie / Trabeculotomy

In this method, the aqueous humor is drained from the anterior chamber by placing an artificial drainage system. The aqueous humor can thus seep out of the anterior chamber of the eye to the conjunctiva; There it is derived via the large vessels of the conjunctiva. The operation is performed under local anesthesia and can often be performed on an outpatient basis. The procedure takes about 30 minutes.

Iridectomy and laser iridotomy

An extension of the angle of the ventricle is useful if narrow-angle glaucoma is present and there is a risk of an angle block (glaucoma case). With a fine knife or a laser beam, a small hole in the iris is punched. The eye water should flow through this hole directly from the rear into the anterior chamber of the eye. This short procedure for the treatment of the Green Star takes place under local eye anesthesia.

Cyclophotocoagulation / cyclocryocoagulation

In cyclophotocoagulation, the ciliary body (the part of the eye on which the eye lens is “suspended”) is overcooked in the area that forms the eye water. This reduces the doctor’s eye water production – the intraocular pressure decreases. In cyclocryocoagulation, the destruction of ciliary body parts forming the eye water does not take place with high-energy light, but with a cold stick. Both methods for the treatment of the Greens are used in secondary glaucoma and glaucoma forms in which other operations are unsuccessful.

Opening of Schlemm’s canal

In this method, the ophthalmologist will search Schlemm’s canal with a probe. This structure in the eye makes a major contribution to the drainage of eye water. From Schlemm’s canal, the surgeon then creates an opening to the anterior chamber of the eye. This glaucoma operation is used on the innate green star.