Glaucoma Surgery
Harley Street, London
When medications and laser treatments cannot adequately control intraocular pressure, glaucoma surgery becomes necessary to preserve remaining vision and prevent further damage. Modern glaucoma surgery has evolved dramatically, offering patients more effective treatments with improved safety profiles and faster recovery times. Miss Shreya Haldar’s expertise encompasses the full spectrum of glaucoma surgical procedures, ensuring that each patient receives the most appropriate treatment for their specific condition.
Glaucoma surgery aims to create new pathways for aqueous humour drainage or reduce its production, thereby lowering intraocular pressure to levels that prevent further optic nerve damage. The decision to proceed with surgery represents a careful balance between the risks of continued pressure elevation against the potential benefits and risks of surgical intervention.
When Surgery Becomes Necessary
The decision to recommend glaucoma surgery is never taken lightly. Surgery is typically considered when maximum tolerated medical therapy fails to achieve target intraocular pressures, when glaucoma continues to progress despite treatment, or when patients cannot tolerate or comply with medical therapy.
Target pressure varies for each patient based on the degree of existing damage, risk factors for progression, and individual circumstances. Some patients require very low pressures to prevent further damage, particularly those with advanced disease or normal-pressure glaucoma.
The rate of glaucoma progression also influences surgical timing. Rapidly progressing disease may require earlier surgical intervention to prevent significant vision loss, whilst slowly progressing disease might be managed medically for longer periods.
Patient factors such as life expectancy, general health, ability to comply with post-operative care, and personal preferences all influence the surgical decision-making process. Miss Haldar works closely with each patient to develop treatment plans that align with their individual circumstances and goals.
Modern Surgical Options
Contemporary glaucoma surgery offers numerous options tailored to different types of glaucoma and patient circumstances. The evolution from traditional techniques to minimally invasive procedures has revolutionised patient outcomes and expanded treatment options.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS represents the most significant advance in glaucoma surgery in decades. These procedures provide effective pressure reduction with excellent safety profiles and rapid recovery times. Many MIGS procedures can be performed in conjunction with cataract surgery, addressing both conditions simultaneously.
The appeal of MIGS lies in its ability to achieve meaningful pressure reduction whilst preserving conjunctival tissue for future procedures if needed. This tissue-sparing approach is particularly valuable for younger patients who may require additional surgeries over their lifetime.
Laser Procedures
Various laser treatments offer effective pressure reduction with minimal invasiveness. Selective Laser Trabeculoplasty (SLT) can be repeated as needed and is often used as first-line therapy or to enhance medical treatment effectiveness.
Cyclophotocoagulation procedures reduce aqueous production by treating the ciliary body. These treatments are particularly valuable for eyes with limited surgical options or refractory glaucoma.
YAG Laser Peripheral Iridotomy (YAG PI) is a highly effective laser procedure for those at risk of angle-closure glaucoma, or for selected cases as a preventive measure. Using a specialised YAG laser, a tiny opening is made in the outer edge of the iris, allowing fluid to flow more freely within the eye and relieving or preventing dangerous pressure build-up. The treatment is performed under local anaesthetic drops, is rapid and minimally uncomfortable, and dramatically reduces the risk of acute glaucoma attacks in susceptible individuals. While YAG PI does not improve sight directly, it plays a vital role in protecting vision and is regularly recommended for patients with ‘narrow angles’ or certain glaucoma types.
Traditional Filtering Surgery
Trabeculectomy remains the gold standard for significant pressure reduction in many glaucoma cases. This procedure creates a new drainage pathway that bypasses the eye’s natural drainage system, often achieving excellent long-term pressure control.
Modern trabeculectomy techniques incorporate antimetabolites and other advances that improve success rates whilst reducing complications. Miss Haldar’s expertise in these procedures ensures optimal outcomes even in challenging cases.
Tube Shunt Surgery
Glaucoma drainage devices provide excellent pressure control for complex cases or when filtering surgery is not appropriate. Modern shunt designs offer improved success rates and reduced complications compared to older devices.
These tube shunt insertion procedures are particularly valuable for cases with conjunctival scarring, previous failed filtering surgery, or certain types of secondary glaucoma.
Pre-Operative Assessment
Comprehensive pre-operative evaluation ensures that patients are appropriate candidates for surgery and helps optimise outcomes. This assessment includes detailed examination of the eye’s anatomy, evaluation of previous treatments and their outcomes, and assessment of general health factors that might influence surgical success.
Miss Haldar evaluates the degree of glaucomatous damage, current intraocular pressure control, and rate of disease progression to determine the urgency and type of surgical intervention needed. Patient factors such as age, life expectancy, and ability to comply with post-operative care are also considered.
The conjunctival health is particularly important for filtering procedures, as previous inflammation, injury, or surgery can affect success rates. Gonioscopy provides crucial information about angle anatomy that influences procedure selection.
Surgical Techniques and Innovations
Miss Haldar employs the latest surgical techniques and technologies to optimise outcomes and minimise complications. Her expertise with both traditional and innovative approaches ensures that patients receive the most appropriate treatment for their specific circumstances.
Advanced MIGS Procedures
The latest generation of MIGS devices, including the iStent infinite, provides enhanced drainage capacity whilst maintaining the safety advantages of minimally invasive techniques. These devices can be used alone or in combination to achieve target pressures.
Miss Haldar’s experience with multiple MIGS platforms allows for personalised device selection based on individual anatomy and pressure reduction requirements.
Enhanced Trabeculectomy Techniques
Modern trabeculectomy incorporates numerous refinements that improve success rates whilst reducing complications. These include advanced wound construction, selective use of antimetabolites, and improved post-operative management protocols.
Miss Haldar’s meticulous surgical technique ensures optimal bleb formation and long-term pressure control whilst minimising risks of complications such as hypotony or infection.
Latest Tube Shunt Technology
The newest generation of glaucoma drainage devices, including the PreserFlo MicroShunt and PAUL Glaucoma Implant, offers improved biocompatibility and flow characteristics. These devices provide excellent pressure control with reduced complications.
Miss Haldar’s expertise in tube shunt surgery ensures proper device selection and placement for optimal outcomes in complex cases.
Post-Operative Care and Monitoring
Successful glaucoma surgery requires meticulous post-operative care and long-term monitoring. The immediate post-operative period is crucial for achieving optimal outcomes and preventing complications.
Early Post-Operative Management
The first few weeks after surgery are critical for establishing proper healing and achieving target pressures. Miss Haldar provides detailed post-operative instructions and closely monitors healing progress through frequent follow-up appointments.
Medications are carefully managed to promote healing whilst preventing complications such as infection or excessive inflammation. Pressure monitoring ensures that target levels are achieved without excessive reduction.
Long-Term Follow-Up
Glaucoma surgery requires lifelong monitoring to ensure continued effectiveness and detect any complications that might develop. Regular examinations assess pressure control, bleb or device function, and overall eye health.
Visual field testing and optic nerve assessment monitor disease stability and detect any progression that might require additional treatment. Some patients may require adjustments to medications or additional procedures over time.
Choosing the Right Procedure
Selecting the optimal surgical procedure requires careful consideration of numerous factors including the type and severity of glaucoma, previous treatments, eye anatomy, patient age and health, and individual preferences and circumstances.
Miss Haldar’s comprehensive approach ensures that all relevant factors are considered in developing personalised treatment recommendations. Her expertise across all surgical modalities means that patients receive unbiased advice about the most appropriate treatment options.
The goal is to achieve adequate pressure control with the least invasive approach that provides durable results. This often means starting with less invasive procedures and progressing to more aggressive treatments if needed.
Why Choose Miss Shreya Haldar for Glaucoma Surgery?
Miss Haldar’s expertise as a consultant ophthalmic surgeon encompasses the full spectrum of glaucoma surgical procedures. Her extensive training and experience ensure access to the most advanced techniques and latest technologies available.
Her commitment to personalised care means that treatment recommendations are tailored to your specific needs and circumstances. The combination of technical excellence and compassionate care provides optimal outcomes whilst ensuring patient comfort and satisfaction.
Located on Harley Street in London, Miss Haldar’s practice provides access to state-of-the-art surgical facilities and the latest surgical technologies. Her collaboration with leading medical institutions ensures that patients benefit from the most current advances in glaucoma surgery.
Her comprehensive approach to glaucoma care extends beyond surgery to include ongoing monitoring and management. This continuity of care ensures optimal long-term outcomes and prompt management of any issues that might arise.
The practice’s commitment to education helps patients understand their condition and treatment options, enabling informed decision-making and realistic expectations about surgical outcomes.
Don’t let glaucoma progression threaten your remaining vision. Miss Shreya Haldar’s expert glaucoma surgery provides the advanced treatment needed to preserve your sight when medical therapy isn’t sufficient.
Contact our Harley Street practice today to discuss your surgical options and take the next step in protecting your precious eyesight. Advanced glaucoma requires advanced treatment, and we’re here to provide exactly that.