You can elect to manage your pterygium conservatively by regularly applying ocular lubricants. This will help alleviate the irritation. Unfortunately your pterygium will not regress with eye-drops alone.

Surgical removal followed by placement of an autoconjunctival graft is the definitive treatment of pterygium. Dr. Kert will discuss this with you, and together you will decide whether or not to proceed.

Reasons to have your pterygium removed include:

1. Documented growth. As the pterygium grows, it will cause permanent scarring which is a concern if it is progressing across your cornea. Growth of the pterygium may in time cause permanent visual loss.
2. Redness that is becoming intolerable.
3. Pain and discomfort that is becoming intolerable.

Pterygium removal is conducted under assisted local anaesthetic or sometimes under general anaesthesia. The operation usually takes 45-60 minutes and you will feel no pain or discomfort during the procedure.

You will go home with oral pain relief, and an eye pad covering the eye. You do not usually need to stay overnight in the Hospital.

Whilst wearing an eye pad you must not drive a vehicle and you must take care walking down stairs and negotiating gutters.

Dr Kert will usually see you one week after your operation.

After your operation, your eye will feel very sore for 3-4 days. It will be watery, feel like gritty sand is inside your lids, and your eye will be very sensitive to light.

There will be eye drops to place in your eye after surgery for 8 weeks. We recommend you take one week off from work/normal duties if possible.

Your eye will be red for 6-8 weeks after surgery.

Like any operation, there are risks. Fortunately these are rare.

There is a 1/20 chance of the pterygium growing back after surgery and this usually happens during the healing phase within the first 6 months. If you have a recurrence you may require a second operation. It is important that you continue the drops as recommended and stay out of the sun as much as possible to minimise the chance of recurrence. Wearing a hat and sunglasses when you go outside can help prevent the pterygium from returning.

Other much rarer risks include infection, bleeding, damage to the vision.

Please feel free to speak with Dr Kert if you have any further questions prior to your operation.

Chronic (primary open-angle) glaucoma is the most common type. It is painless.
Damage progresses very slowly and destroys vision gradually, starting with the side vision. Early on the person remains unaware of any problem. Glaucoma may only be noticed when a majority of nerve fibres have been damaged, and a large part of vision has been destroyed. This damage is irreversible. It is progressive and usually relentless. Treatment cannot recover what has been lost. Treatment can arrest, or at least slow down the damage process. That is why it is so important to detect the problem as early as possible, to be able to start treatment with as little damage to the vision as possible.

Although anyone can get glaucoma, some people have a higher risk, those with

• A family history of glaucoma
• Diabetes
• Migraine
• Short sightedness (myopia)
• Long sightedness (hyperopia)
• Eye injuries
• Past or present use of cortisone drugs (steroids)

Most patients will see Dr Kert every six months for a glaucoma assessment. The assessment will involve checking the vision, the intraocular pressures and looking at the optic disc. Other tests are usually performed such as visual fields, OCT imaging of the optic disc and glaucoma parameters and fundus photography.

At each visit, Dr Kert will assess the progression of your glaucoma and may make changes to your glaucoma treatment. The treatment and surveillance of the condition are life long as there is no cure for glaucoma.

1. Topical medication (eye drops)

Eye drops are usually the first line management of glaucoma. Instructions of how to instil eye drops can be found here.

2. Selective Laser Trabeculoplasty, or SLT

Selective Laser Trabeculoplasty, or SLT is a form of laser surgery that is used to lower intraocular pressure in glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It may sometimes be used as initial treatment in glaucoma. SLT has been in use for 12 years in Australia and around the world.

3. Minimally Invasive Glaucoma Surgery ( MIGS) 

MIGS refers to a group of tiny devices or implants that can be surgically placed inside the eye to assist in the drainage of fluid to compartments outside the eye. The device is carefully placed inside the eye during a surgical operation in the operating theatre . It increases the outflow of fluid from the eye ( aqueous) thereby reducing the intra-ocular pressure. 

3. Trabeculectomy

A trabeculectomy is a more invasive surgical  operation that works to lower the intraocular pressure. It is conducted in the operating theatre and is generally reserved for the more serious types of glaucoma where the intraocular pressures cannot be controlled by more conservative means.

Who is a candidate for SLT?

Patients who have open-angle glaucoma (the drainage system in the front part of the eye is open) and are in need of lowering of their intraocular pressure (IOP) are eligible for the procedure. Dr Kert  will make the final determination if you are a candidate.

How does it work?

Laser energy is applied to the drainage tissue in the angle of the eye. This starts a chemical and biological change in the trabecular meshwork tissue. This allows the aqueous fluid to drain out of the eye more effectively. This eventually results in lowering of intraocular pressure. It may take 1-3 months for the laser to effect a  lowering of the eye pressure.

Why is it called Selective?

The type of laser used has minimal heat energy absorption because it is only taken up by selected pigmented tissue in the eye. Sometimes it is referred to as a ‘cold laser.’ Because of this, the procedure produces less scar tissue and has minimal pain.

What are the risks of SLT?

One key aspect of SLT is a favourable side effect profile, even when compared with glaucoma medications. Post-operative inflammation is common but generally mild, and treated with observation or eye drops or an oral non-steroidal anti-inflammatory drug. There is an approximately 5% incidence of intraocular pressure elevation after laser, which can be managed by glaucoma medications and usually goes away after 24 hours.

How effective is SLT?

SLT lowers the intraocular pressure by about 30% when used as initial therapy in most patients. This is comparable to the intraocular pressure lowering of the most powerful and commonly used class of glaucoma medication (prostaglandin analogs). This effect may be reduced if the patient is already on glaucoma medications.

How long does the effect last?

The effect will generally last between 1-5 years, and in rare cases, longer than that. If it does not last at least 6-12 months, it is usually not considered successful.

What happens if it wears off?

If SLT is effective at lowering intraocular pressure but this wears off over several years, the procedure can be repeated but the second treatment may not be as effective as the first and may not last as long. If SLT is not initially successful, repeat treatment is not likely to be effective. Alternatively, glaucoma medication can be used if the effect wears off over time.

What happens if it doesn’t work?

If SLT fails to lower the intraocular pressure, then the glaucoma is treated by other means such as medications or Minimally invasive glaucoma surgery ( MIGS) or conventional glaucoma surgery such as trabeculectomy. The laser does not affect the success of these other types of treatment.

What is the cost?

Since the procedure is an accepted glaucoma treatment, and is approved, it is covered by Medicare. The cost will be discussed with you prior to proceeding. The Medicare Safety Net can assist you in covering most of the out of pocket expenditure.

Will I still need to use glaucoma medications?

Some patients can be controlled with just laser treatment. Others require additional intraocular pressure lowering and may therefore need to use glaucoma medication as well. Think of the SLT as equivalent to one glaucoma medication. Just as some patients will require more than one glaucoma medication to control their intraocular pressure, some may also require laser plus one or more glaucoma medications. It is important to remember that SLT is not a cure for glaucoma, just as medication and surgery are also not cures for glaucoma .

Glaucoma is a lifelong condition with no cure. Management requires life long follow up to ensure each patient achieves the best possible vision in the later years .

Whatever method is used to treat glaucoma, continuing appropriate follow up and testing at Darling Downs Eye is critical.

If you have any further questions feel free to call the team at Darling Downs Eye to discuss further.

Why has my doctor recommended this operation?

Glaucoma may get worse if the pressure inside the eye is not low enough. Trabeculectomy is recommended when eye drops are not controlling the pressure and there is a significant risk that glaucoma is going to cause further damage to your sight.

What is trabeculectomy?

A trabeculectomy is an operation to make the pressure lower inside the eye. It involves making a new channel in the white wall of the eye (sclera), through which fluid flows out into a space underneath the outer layer of the eye (conjunctiva). A successful trabeculectomy creates what we call a ‘bleb’, a small elevation which is usually covered by the upper eyelid.

What anaesthetic is used?

Trabeculectomy is usually done as a day case under general anaesthetic. It can also be performed under local anaesthetic or eye block with sedation.

What happens after the operation?

Frequent follow-up is required in the first few weeks and months after this operation. All patients need to be reviewed the day after surgery then, if all is well, a week later and again one to three weeks after that. The exact timing of these and future reviews depends on how the eye is settling down, and more frequent visits are quite often required.
The first few weeks after the operation are very important for checking the eye and for carrying out adjustments. Most of these adjustments are minor and will be done as part of the outpatient visit. It is best to avoid planning any holidays within two months after the operation.
If you already have a holiday planned, you do need to discuss this with Dr Kert , and schedule the surgery appropriately.

What will my vision be like?

It is common for the eye that has had the surgery to be quite blurred for a few weeks, sometimes longer. There is no need to change your glasses straight away, but some patients will benefit from updating their glasses sooner than they normally would, although it is best to wait for three months while things settle. You can resume driving after a few days  (if this applies to you) if your vision is sufficient for you to meet the legal requirements. Trabeculectomy does not improve vision – its purpose is to prevent sight loss in the future.

What can I and can’t I do after trabeculectomy?

Returning to work
Most people can return to office-based work two weeks after the operation though sometimes longer is needed. It is usually wise to wait at least a month before resuming physically strenuous work or work in a dusty/dirty environment. Dr Kert will advise you in more detail about this at your postoperative checks.

Activity
You can use your eyes for reading, television, computers etc as soon as you wish – this will not harm your eye. Gentle exercise (walking) is fine, but you should expect to avoid strenuous exercise (running, ball sports, fitness workouts), or lifting heavy objects for at least a month after the operation.
Swimming or immersing the eye should be avoided for at least one month – please ask at your check-up if you wish to resume swimming. It may be useful to keep the clear shield on your eye, or wear glasses for the first week after the operation, for the protection that it offers.

How successful is trabeculectomy?

The operation helps lower the pressure in the eye in about 90% of cases, and most patients will not need glaucoma drops in the eye that has had the operation. A lower pressure is beneficial to nearly all patients with glaucoma, but glaucoma can still progress – in some cases even after a ‘successful’ trabeculectomy.

Trabeculectomy can fail over time and may need adjustments such as ‘ needling ‘ procedures to break down adhesions and scar tissue as they form. This is to ensure outflow is maintained.

What are the risks and complications of trabeculectomy?

We always need to consider the risks as well as the potential benefits before going ahead with an operation. If this surgery has been recommended then Dr Kert will have judged that the risk to your sight from glaucoma (without the operation) is greater than the risks of the operation itself.
For most patients trabeculectomy achieves a lower pressure without any significant problems; however, all operations do have some risks and for trabeculectomy these include:

• Reduced vision
  This is very common in the first two weeks, due to swings in the pressure
• Minor bleeding inside the eye
  These typically settle within the first few weeks. Some patients (five to eight percent) may have some degree of permanently reduced vision after the operation. Loss of all vision in the eye due to the surgery itself is very unusual, but as with all intraocular surgery can very rarely occur.
• Discomfort
  This usually settles within a few weeks, but some patients experience long-term discomfort. These symptoms are usually mild and can be controlled with artificial tears.
• Increased likelihood of cataract
  This is quite common within five years. If it does occur, it can be treated in the normal way. In some patients a trabeculectomy works less well if a cataract operation is performed subsequently. Dr Kert  may elect to perform cataract surgery prior to the trabeculectomy.
• Infection and loss of vision in the eye
  There is a small risk of infection after any eye surgery including trabeculectomy. Additionally, after trabeculectomy there is a permanently-increased risk of infection getting inside the eye. The risk is small, roughly one in a thousand.

Further surgery may be required to make the operation succeed, or to correct low pressure. It is not unusual for an additional procedure of some sort to be required – usually this is a much shorter procedure than the trabeculectomy itself ( such as a bleb needling procedure )

Further information

If you have any further questions feel free to call the team at Darling Downs Eye to discuss further.