Glaucoma & Adnexal Molecules (Clinic)
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The clinic offers the possibility of diagnosis, monitoring and treatment of all types of Glaucoma, as well as Special Diseases of the Adnexa. The philosophy of the department is the holistic and individualized treatment of the patient. The clinic has experienced staff, which is well trained in well-known centres abroad.
Through the clinic there is the possibility of a complete diagnostic test in a single visit. At the same time, there is access to the most effective, safe and modern treatments, such as the minimally invasive glaucoma surgery (Microinvasive Glaucoma Surgery), but also to classic anti-glaucoma procedures, such as trabeculectomy and the Ahmed and Baerveldt anti-glaucoma drainage devices. The possibility of SLT Laser Trabeculoplasty and YAG Laser Iridotomy is also available on an outpatient level.
Glaucoma is a chronic condition that can lead to blindness due to the gradual and irreversible degeneration of the optic nerve. In most cases, this occurs due to increased pressure in the eye (intraocular pressure). There are usually no symptoms until the disease is in an advanced stage.
Advanced age (people over 55 years old), but also a family history, are among the most important risk factors. Other risk factors include race (more common in people of African, Latin American and Asian descent), a history of diabetes, hypertension or some cases of nocturnal hypotension, migraines, sleep apnea syndrome, previous injury or inflammation of the eye, the use of any form of steroids for a long period of time, and increased myopia or hyperopia.
For this reason, the American Academy of Ophthalmology recommends a regular eye exam every 5 years for people between the ages of 20 and 40, every 2-4 years for people over 40 and up to age 54, every 1-3 years between the ages of 55-64, and every 1-2 years after age 65. The interval between regular eye examinations should be individualised, depending on risk factors. People with a family history or a history of diabetes should be examined at least once a year after the age of 40.
Sometimes there can be a delay in diagnosis or starting treatment, which can be detrimental to the long-term prognosis. For this reason, monitoring by qualified and experienced staff is recommended.
With regard to Specific Diseases of the Adnexal Molecules, these include the existence of cataracts with lenticulopathy due to pseudoapophthalmia or previous trauma, intraocular lens displacements/paratectomies, the existence of aphakia on the ground of cataract surgery at a young age, as well as other cases described below. Often, these conditions co-exist with Glaucoma and therefore the treatment of these conditions is often performed by specialist ophthalmic surgeons with expertise in both areas.
Glaucoma:
-Protopic Open Angle Glaucoma
-Protopic Closed-Angle Glaucoma
-Ophthalmophthalmic Glaucoma
-Ragoid Glaucoma
-Melanchromatic Glaucoma
-Neovascular Glaucoma
-Juvenile Glaucoma
-Other Secondary Glaucomas (steroid-related, post-corneal transplant, lentiginous, lentiginous, aniridia-related)
Specialised anterior particles:
-Cases of cataracts with phacoemulsification
-Replacement of intraocular lens
-Rectomies/translocations of intraocular lenses with repositioning or replacement of the intraocular lens.
-Fitting intraocular lenses in cases of aphakia
-Treatment of surgical diseases of the iris (trauma, deficit) with iridoplasty methods
-Complete ophthalmological examination in the slit lamp
-Tonometrics
-Gonitoring
-Corneal pachymetry
-Control and monitoring of optical fields with automatic Humphrey perimetry (Zeiss)
-Imaging of the optic nerve and anterior molecules with OCT (Topcon Triton Swept Source OCT)
-Starting or continuing treatment and counselling regarding the long-term disease management plan
*Sometimes it is necessary to have the pupil in the room and therefore it is recommended that an attendant is present with the patient.
Glaucoma treatment is divided into pharmaceutical, laser and surgical treatment.
Drug treatments with eye drops are in most cases quite effective. Sometimes, however, they can lose their effectiveness in controlling eye pressure, which usually leads to a worsening of glaucomatous disease and progressive loss of vision. At the same time, some patients may develop intolerance to these eye drops, especially during chronic use.
Laser treatment is indicated in certain cases of closed-angle glaucoma, where a small incision is made in the iris (YAG Laser iridotomy) and often improves the anatomy of the anterior chamber by reducing intraocular pressure. In recent years, there has been an increase in the use of Selective Laser Trabeculoplasty as initial treatment for new diagnoses of open-angle glaucoma or cases of Ocular Hypertension, instead of the use of colloids. Large clinical studies have shown excellent results from the use of laser SLT in these cases. SLT laser can also be used as an adjunct to the use of antiglaucoma colloids to achieve better control of intraocular pressure in selected cases. These two types of lasers are available at the "Agios Loukas" Ophthalmology Clinic and can be combined with the diagnostic eye visit.
As far as surgical treatment in glaucoma is concerned, it aims to significantly reduce intraocular pressure in more advanced cases of glaucoma or in cases where the intraocular pressure is too high and cannot be controlled with eye drops or oral medication. The most commonly performed procedure is that of trabeculectomy with antimetabolites or Ahmed and Baerveldt-type antiglaucoma drainage devices.
In recent years, there has been a revolution in the field of glaucoma surgery due to the development of minimally invasive surgical techniques (Microinvasive Glaucoma Surgery -MIGS). These techniques usually involve the use of special micro-implants and are often combined with cataract surgery, offering a balanced efficacy and safety profile compared to traditional anti-glaucoma procedures. In this way, targeted interventions can be made early, improving the long-term outcome of the disease. It is very important that these interventions are performed by highly trained surgeons and that patients are properly selected.
Through the clinic, there is access to all of the above techniques, enabling the full personalization of the treatment of the glaucomatous patient.
Through special surgical techniques, the aforementioned cases (complicated cataract cases, intraocular lens diseases, aphakia) can be treated in a safe way, improving the vision of people suffering from such diseases.
Departmental Scientific Officer:
Dr Thomas Siempis, MD, FRCOphth
Glaucoma, Cataract and Adnexal Molecule Surgeon
Trained in the UK and retrained in Canada
Glaucoma and Advanced Anterior Segment Fellowship, University of Toronto
Honorary Clinical Lecturer University of Glasgow
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