I had agreed to the newer physical intervention treatment and that is by laser surgery. This treatment is quite new, only approved by the US FDA in 2001 for general use. It involves the use of a high powered laser to “shoot” holes in the trabecular meshwork to assist with the drainage of the aqueous humor, thereby allowing increased drainage, and so to reduce the build up of intraocular pressure. The procedure is less complicated than intrusive surgery, involves less actual physical damage so reducing amount of treatment and also the threat of infection and bleeding that may occur with traditional physical measures. These are the main issues that make the procedure attractive to both doctors and patients alike. A very precise laser beam is focused on the trabecular meshwork, and actually burns holes therein so that it can possibly allow for increased drainage of the fluid as it is produced. The success rate for patients with exfoliation syndrome is encouraging but certainly not conclusive (this process being so new there is little historic data to build up a good medical picture and allow for better prediction of results).

Paradox

With this procedure there is also a possibility for a negative effect. I had not researched this a lot just yet as it was not particularly relevant to me until now. It was described to me as paradoxical rise in intraocular pressure after the procedure. How this happens I don’t really know and seems that this being such a new and not so widely trialed process, even the medical fraternity really knew what to expect. However, it was described to me as a "paradox" which I took to mean that If it were known, then they would not call it as such.

No doubt, this is just another of the wide range of possible anomalies with certain individuals but again, there has not been enough experience to allow the full research into this issue. I guess it was offered to me as part of the need to gather data from real people in real situations.

I consented to the procedure in my case to prove two points: First, that I thought that, at best, it would be (assuming it worked to optimistic prediction) a shorter term fix as indicated by my research, and second that if it showed very good results it may be helpful to suffers around the world to make informed choices as presented by their medical professionals.

My personal experience of the laser procedure in detail is that I arrived at the hospital and was directed to the room specially set up for this procedure. The doctor arrived and did a quick check of the progress of my disease but only by checking the intraoccular pressure. We concluded again that the pressure was not going to be sufficiently controlled by medication alone and so he suggested we proceed with the laser treatment.

This, as complicated as it may sound, was actually quite simple from a patients’ perspective. The equipment is, of course, quite high tech, and the laser has to be controlled in intensity and directed very precisely to the site. After first applying an anesthetic to my eye, I sat up to the machine with my head on a jig to keep it very still. He can then manipulate a lens directly in contact with the front of my eye. Through this lens he is able to actually see inside the eye chamber and also aim and fire the laser shots into the trabecular meshwork. He gave me 50 shots, so in effect, burned in 50 tiny holes to try to assist the drainage process. The laser flashes appeared to me to be a forest green in color but were quite painless. Naturally this makes the eye very irritated and red, and I was told that around six weeks is required for a healing and settling down before it can be fully determined to what degree the process has helped the condition.

Nice try but no cigar

Unfortunately, in my case, the laser treatment was not successful, and seemed to give no benefit with allowing the pressure to be lowered and keep me out of the danger zone. After three weeks of more pressure spikes and generally high pressure readings it became clear that I needed to proceed to the full trabeculectomy operation in order to get the results needed. Because of my previous surgery in Australia 15 years ago, it is now more difficult and the doctor has warned that complications are much more likely and the success rate is lower than for first time operations. He quoted a success rate of only around 50 to 60% which was not very encouraging, but given that we had exhausted all other avenues of treatment, it was time to get on with it without delay.

And so we move on with the story in the next post, Trabeculectomy #2