Area doctor offers new type of glaucoma surgery

Everett Hedeen had undergone eye surgery to relieve pressure caused by glaucoma in his right eye. He knew the day was coming when he would be facing another surgery.

The other thing he knew? He did not want to undergo another trabeculectomy, which has long been the standard procedure used by ophthalmologists but has a high risk of infections.

“About 10 or 12 years ago, the pressures got high enough that the doctor recommended surgery,” Hedeen, 74, Lenexa, said. “About nine months after, and he was a good doctor and did everything right, I got a series of two infections.

“With trabeculectomy, there’s a risk of getting infection and for those who get it, it’s 100 percent. The second infection was poly staph infection and required emergency surgery and he was able to save the eye. But it did a lot of damage.”

A few years later, Hedeen was told he needed the same procedure for the glaucoma in his left eye. At that point he decided to get a second opinion and asked his brother-in-law in Salina if he knew of anyone.

“He recommended Dr. (Michael) Stiles,” Hedeen said. “He treated me for a year with medicines, and watching the pressures. Then he said he thought it was time (to do the surgery) and he said he had a new procedure with no incidence of infection because it’s not as invasive as trabeculectomy.”

Stiles, who has been practicing in the Kansas City area for 20 years, the past three in Overland Park, now is doing a procedure called canaloplasty. Think of it as an angioplasty for the eye.

Glaucoma is a disease of the optic nerve, which is comprised of nerve fibers that carry images to the brain. Normally, clear fluid is produced in the ciliary body behind the iris and slowly moves to the front of the lens and through the pupil and out the eye through the trabecular meshwork.

Glaucoma stops the exit of the fluid because the meshwork is blocked by iris tissue. Pressure in the eye can increase to a point that causes damage to the optic nerve.

“There’s a canal called Schlemm’s canal that is where most of the fluid inside your eyes go and then is deposited into your vein and it’s in that area where the obstruction to outflow is glaucoma and where the pressure becomes elevated,” Stiles said. “We used to, and still do, bypass (trabeculectomy surgery) that canal by producing an artificial tunnel in the sight wall of the eye or putting a tube inside the eye like a heart bypass.

“(With canaloplasty) we dissect down to that (Schlemm’s) canal that’s only about 250 microns in diameter and we are able to put a micro catheter into that canal and dilate it and that allows us to place a permanent stent or suture material that goes all the way around inside that canal so that it lowers the pressure more efficiently.”

Stiles learned about the procedure nearly three years ago but didn’t begin offering it to patients until about 18 months ago, waiting mainly because of the availability of the technology.

“And I just wanted to wait and see before I took that leap that the procedure was really panning out to be that much better before I put myself through the training and that learning curve,” Stiles said. “It’s a difficult procedure to learn.”

Canaloplasty results were impressive and Stiles said he took the course, practicing on donated eyes that were not suitable for transplantation.

“I feel very comfortable with the procedure and I feel like it’s a big advantage for patients who are candidates over traditional glaucoma surgery,” he said. “There’s virtually no pain and what we’re finding is that there is similar pressure reduction and we’re also seeing a lower complication rate because it is less invasive.

“(Trabeculectomy) still is the common procedure being used, but canaloplasty is slowly being adopted. Treating glaucoma, we’re not improving vision we’re trying to prevent vision loss.”

There are no symptoms for glaucoma except in the later stages when there is decreased vision. People do not feel the pressure buildup.

“It has to be diagnosed by an eye care professional,” Stiles said. “And there are certain groups that should be checked: patients over 60, African-Americans, Latinos, patients with a history of elevated pressure, and patients who have a family history of glaucoma.”

Canaloplasty is covered by most insurance including Medicare.

As with any surgical procedure, Stiles warns that complications are possible.

Hebeen said he was extremely pleased with his experience.

“The outcome has been totally positive for me,” he said. “There are no operative issues with it at all. It’s all outpatient; you walk in, you walk out and you’re fine with no after affects.

“There was no pain, none whatsoever. You’re conscious during the entire procedure and there’s nothing you have to do other than not move. It was not difficult from any aspect of having done it.

“And my advice to others would be that if Dr. Stiles recommends it to them, I would do it.”

Trackback(0)

TrackBack URI for this entry

Comments (0)

Write comment