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'Space-age' Glaucoma Treatment a first for the South West

3 June 2013


In the run-up to national glaucoma awareness week (8-14 June), the Royal Devon and Exeter NHS Foundation Trust is celebrating being the first in the South West to offer new, ‘space-age’ laser surgery for glaucoma.


The Trust’s West of England Eye Unit has recently acquired a state-of-the-art laser micro-endoscopy unit, which makes glaucoma surgery safer, faster and more convenient for patients. So far, the equipment is only available in around a dozen hospitals in the UK.

Consultant Ophthalmologist, Mr Michael Smith, is one of two glaucoma specialists at the RD&E trained to use the new equipment. He explains: “Glaucoma is a condition of the eye that if untreated can lead to blindness. Treatment involves lowering the eye pressure and in most patients this is achieved with eye drops. If this isn’t effective, surgery is required. Traditional glaucoma surgery involves creating a new channel that will drain fluid from the eye and reduce pressure. Although this is an effective procedure it does involve significant risks and inconvenience to patients. However, we’re now one of just a handful of hospitals in the country approaching the surgery in a different way. Rather than improving the outflow of fluid we are targeting the structure in the eye which produces the fluid. Although not a new idea, recent advances in technology mean we can now do this in a very targeted manner which improves the effect and reduces unwanted side effects.. Not everyone is suitable for this kind of surgery, but in Exeter already over 50 patients have benefited from the procedure, and the results so far have been very positive.”

Conventional glaucoma surgery is usually effective, but it takes around 45 minutes and requires the patient to lie still for all that time. It also has a number of potential side effects such as reduced vision and wound problems, which are a particular concern in elderly patients. Following the surgery the eye needs to be checked every few weeks for three months and therefore many hospital visits are required. Surgeons also usually prefer to remove any cataract which is present prior to undertaking glaucoma surgery and this means an additional operation.


The new procedure only takes 10-15 minutes, and can be done at the same time as cataract surgery. Everything is done under local anaesthetic and fewer follow up visits are needed.


During the new procedure, known as Endocylodiode Photocoagulation (ECP), the surgeon uses a micro-endoscopy probe to access the eye through a 2mm incision. The probe contains a telescope, a laser and an aiming beam for the laser. Using the telescope the surgeon views the inside of the eye on a screen and navigates around the eye until the ciliary body is visible. This is a 5mm-wide ring around the eye, which produces the fluid that gives the eye its shape and nutrients. The surgeon delivers controlled laser to this part of the eye, reducing its ability to produce fluid and ensuring reduced pressure within the eye.

The new technology costs £45,000 and was purchased using charitable funds donated by past and present patients of the West of England Eye Unit. The ongoing costs are met by the RD&E.


According to Mr Smith, “we still have no cure for glaucoma but for selected patients who require surgery, this procedure offers a quicker and safer alternative to conventional glaucoma surgery”.

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