Mr. Zhang, aged sixty-one, retired from a computer company two years ago and returned to Taichung to enjoy farming. In October 2021, he felt a foreign body sensation in his eyes, which he initially ignored. However, as the discomfort worsened, he sought treatment from Dr. You-Ling Li, an ophthalmologist at China Medical University Hospital. Mr. Zhang was diagnosed with severe corneal ulceration caused by a fungal infection. This ulceration eventually healed but left a corneal scar, leading to complicated glaucoma. Zhang almost lost his right eye's vision, measuring less than 0.01, and multiple complications, such as iridocorneal adhesions and neovascularization of the iris. The blockage of aqueous humor drainage between the cornea and the crystalline lens caused eye pain and headaches, even after medication and laser treatment. His intraocular pressure remained high at 40-50mmHg (standard intraocular pressure is below 21mmHg). Dr. Li suggested glaucoma tube implantation surgery with intraoperative optical coherence tomography (OCT) for precise location. An ultra-fine drainage tube was implanted with pinpoint accuracy to facilitate aqueous humor drainage and intraocular control pressure by directing it toward the reservoir area. After surgery and recovery, Mr. Zhang's eye pain and discomfort subsided, and his intraocular pressure stabilized at 10mmHg. He now eagerly awaits corneal transplantation to restore his vision.
Dr. You-Ling Li further commented that glaucoma is an irreversible optic nerve disease, and the complex glaucoma blindness rate is very high. It can cause visual field defects and affect central vision, leading to blindness. According to the Ministry of Health and Welfare statistics, more than 340,000 Taiwanese suffer from glaucoma. High-risk groups susceptible to glaucoma include those with a family history of glaucoma, diabetes, or hypertension, those over 60 years of age, highly myopic or hyperopic individuals, and patients with autoimmune diseases and cardiovascular diseases as those who frequently look down at 3C devices without moving their posture. There is also a trend of younger onset in recent years. Initially, eyeballs secrete "aqueous humor" to maintain normal physiological functions. When not discharged promptly, it can eventually lead to increased intraocular pressure. Then, the optic nerve at the bottom of the eye would be damaged. Therefore, "controlling intraocular pressure and facilitating aqueous humor drainage" is the primary method to reduce damage to the optic nerve in glaucoma patients. Dr. Li said there are three steps to controlling intraocular pressure: eye drops, laser treatment, and surgery. Glaucoma surgery may achieve lower or more stable intraocular pressure control when intraocular pressure control is not durable enough, or the side effects of medication are difficult to tolerate.
Dr. You-Ling Li points out that the success rate of traditional "trabeculectomy" surgery for treating glaucoma can be affected by the type of glaucoma and the individual's physical constitution and scar healing ability. Although anti-fibrosis agents have been used to control scar healing, gradual obstruction of the outflow tract occurs within years after surgery, leading to increased intraocular pressure. This is particularly true for some severe and refractory glaucomas, such as uveitis-associated and neovascular glaucoma. A glaucoma drainer can allow aqueous humor to drain through an implanted tube and collect in a reservoir. For patients with the urgent need for intraocular pressure reduction, uveitis-associated glaucoma with considerable fluctuating pressures, and early-stage neovascular glaucoma, a valved drainage device should be selected; For patients with strict pressure requirements, a valveless drain device should be used.
Dr. You-Ling Li points out that since April 2022, when the National Health Insurance began reimbursing patients for "glaucoma drainage devices" after their first traditional surgery failure, the ophthalmology team at China Medical University Hospital has been utilizing "intraoperative optical coherence tomography (OCT) for navigation during eye surgery. This technique uses high-precision stereoscopic analysis to accurately determine the location of the drainage tube while also reducing bleeding risk and minimizing corneal endothelial damage. It is critical for surgical success. In a 5-year clinical study of TVT, for patients aged 18 to 85 who had undergone trabeculectomy, the success rate of using glaucoma drainage implantation for the second time was higher than that of trabeculectomy.
Dr. You-Ling Li emphasizes that early diagnosis and treatment are essential for preventing glaucoma progression. While current therapies can only delay their progression, early detection and evaluation by a professional physician and selecting appropriate medication or surgical methods can help maintain the quality of life for glaucoma patients.