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Glaucoma Treatment: Drops, Laser & Surgery to Preserve Vision

Glaucoma has no cure, but treatment lowers intraocular pressure (IOP) to slow or halt optic nerve damage. Therapy is individualized by type, severity, and patient factors.

First‑Line: Topical Medications

ClassExamplesMechanismTypical Dosing
Prostaglandin analogsLatanoprost, travoprost, tafluprost, bimatoprost↑ uveoscleral outflow1 drop nightly
Beta‑blockersTimolol, betaxolol↓ aqueous productionBID
Alpha‑2 agonistsBrimonidine↓ production + ↑ uveoscleralBID–TID
Carbonic anhydrase inhibitorsDorzolamide, brinzolamide↓ productionBID–TID
Rho kinase inhibitorNetarsudil↑ trabecular outflowNightly
Combination dropsFixed‑dose combos (e.g., latanoprost/timolol)Dual mechanismPer components

Laser Procedures

  • Selective Laser Trabeculoplasty (SLT): First‑line or adjunct for POAG; stimulates trabecular meshwork; repeatable; ~75% success at 1 yr.
  • Laser Peripheral Iridotomy (LPI): For angle‑closure / narrow angles; creates hole in iris.
  • Micropulse/Endocyclophotocoagulation: Cyclodestructive for refractory cases.

Incisional Surgery

  • Trabeculectomy: Gold‑standard filtering surgery; creates guarded fistula; mitomycin‑C/5‑FU antimetabolites.
  • Glaucoma Drainage Devices (tubes): Ahmed, Baerveldt, Paul — for refractory/secondary glaucomas.
  • MIGS (Micro‑Invasive Glaucoma Surgery): iStent, Hydrus, OMNI, Kahook Dual Blade — safer, modest IOP drop; often combined with cataract surgery.

Monitoring

  • IOP checks (diurnal variation).
  • OCT RNFL/GCIPL every 6–12 months.
  • Visual fields annually (or more if progressing).
  • Target IOP: individualized (typically 20–30% reduction from baseline).

Adherence Is Key

Preservative‑free formulations, once‑daily dosing, reminder apps, and patient education improve compliance—the #1 factor in long‑term control.

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