Treatment Principles in Glaucoma

Dear Colleagues,

Prevalence of glaucoma is increasing and the area of glaucoma treatment is on the move.

Intraocular pressure (IOP) is still the only treatable risk factor in glaucoma, and its lowering by surgical intervention has been associated with a decreased speed of progression of the disease.

If we look back 20 years, treatment options for primary open angle glaucoma were medication, laser and mostly trabeculectomy or deep sclerectomy. Depending on the country and in cases of severe and treatment resistent glaucoma, glaucoma drainage implants were used as first choice.

This special issue will cover the change of glaucoma treatment regimes over time and will discuss new developments in glaucoma surgery over the last years.

Although medical therapy is still the first choice in a patient with newly diagnosed glaucoma, there seems to be a paradigm change towards earlier and more progressive approaches. 

Laser treatment is another option in patients that do not react to antiglaucomatous eye drops. Argon laser trabeculoplasty and/or selective laser trabeculoplasty are procedures that can lower IOP in some patients that have trouble with ocular surface disease (dry –eye syndrome, inflammation due to eye drops) or that are less compliant in regular application of their eye drops.  A randomized control study did not show any statistically significant difference between medication and laser treeatment (REF).

Trabeculectomy is worldwide the standard surgery for IOP control in glaucoma disease.

Long -term results over 20 years have been shown that approximately 60% of performed trabeculectomies were succesful (without medication) and 90 % with medication. A multicenter analysis has found an overall long-term success rate of 80% in 395 patients undergoing trabeculectomy.

However, the relatively high incidence of complications of trabeculectomy has encouraged the development of new, less invasive surgical methods. These interventions can be used earlier in the disease and aim to fill the gap between medication and standard trabeculectomy. Some of these pocedures can be used in combination with cataract surgery, having a charming opportunity of fighting against both, cataract and glaucoma in one session. However, advantages and disadvantages and the current status of literature will be discussed in this special issue in detail.

Prof. Dr. Esther M. Hoffmann
Dr. Julia Lamparter
Guest Editors

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• Glaucoma treatment
• Medical therapy
• Laser Therapy
• Filtering glaucoma surgery
• Non-penetrating glaucoma surgery
• Wound healing
• Minimal invasive glaucoma surgery