 an elevated pressure, the therapeutic approach currently available in glaucoma is to reduce the intraocular pressure.
The clinical treatment of glaucoma is typically carried out in a step-wise manner. Medication often is the first treatment option. Administered either topically or orally, these medications work to either reduce aqueous production or they act to increase outflow. Currently available medications have many serious side effects including: congestive heart failure, respiratory distress, hypertension, depression, renal stones, aplastic anemia, sexual dysfunction and death. Compliance with medication is a major problem, with estimates that over half of glaucoma patients do not follow their correct dosing schedules.
When medication fails to adequately reduce the pressure, laser trabeculoplasty often is performed. In laser trabeculoplasty, thermal energy from a laser is applied to a number of noncontiguous spots in the trabecular meshwork. It is believed that the laser energy stimulates the metabolism of the trabecular cells in some way, and changes the cellular material in the trabecular meshwork. In a large percent of patients, aqueous outflow is enhanced and IOP decreases. However, the effect often is not long lasting and a significant percentage of patients develop an elevated pressure within the years that follow the treatment. The laser trabeculoplasty treatment is typically not repeatable. In addition, laser trabeculoplasty is not an effective treatment for primary open angle glaucoma in patients less than fifty years of age, nor is it effective for angle closure glaucoma and many secondary glaucomas.
If laser trabeculoplasty does not reduce the pressure sufficiently, then incisional surgery (typically referred to as filtering surgery) is performed. With incisional surgery, a hole is made in the sclera 26 adjacent the angle region. This hole allows the aqueous fluid to leave the eye through an alternate route.
The most commonly performed incisional procedure is a trabeculectomy. In a trabeculectomy, a posterior incision is made in the conjunctiva 30, which is the transparent tissue that covers the sclera 26. The conjunctiva 30 is rolled forward, exposing the sclera 26 at the limbus 32, which marks the junction between the sclera 26 and the cornea 34. A partial scleral flap is made and dissected into the cornea. The anterior chamber 20 is entered beneath the scleral flap, and a section of deep sclera 26 and trabecular meshwork 20 is excised. The scleral flap is loosely sewn
an elevated pressure, the therapeutic approach presently available in glaucoma is to repress the intraocular pressure. 
 The clinical treatment of glaucoma is typically impart out in a footstep - wise manner. Medication much is the beginning treatment choice. distribute either topically or orally, these medication work to either reduce aqueous output or they work to increase outflow. Currently available medications have many serious slope effects including: congestive heart bankruptcy, respiratory distress, hypertension, depression, nephritic stones, aplastic anemia, intimate dysfunction and death. Compliance with medication is a major problem, with estimates that over half of glaucoma patient do not follow their correct dosing schedules. 
 When medication fails to adequately reduce the pressure, laser trabeculoplasty often is performed. In laser trabeculoplasty, thermal energy from a laser is applied to a number of noncontiguous spots in the trabecular meshwork. It is believed that the laser energy stimulates the metamorphosis of the trabecular cell in some way, and transfer the cellular fabric in the trabecular net. In a large percent of patients, aqueous outflow is enhanced and IOP decreases. However, the effect often is not long last and a significant percentage of patients develop an elevated pressure within the year that follow the treatment. The laser trabeculoplasty treatment is typically not repeatable. In addition, laser trabeculoplasty is not an effective discussion for primary receptive slant glaucoma in patient less than fifty years of age, nor is it effective for angle blockage glaucoma and many secondary glaucomas. 
 If laser trabeculoplasty does not reduce the atmospheric pressure sufficiently, then incisional surgery (typically referred to as filtering surgery) is performed. With incisional operation, a hole is make in the sclera 26 adjacent the angle region. This fix allows the aqueous fluid to exit the eye through an alternate path. 
 The most normally performed incisional procedure is a trabeculectomy. In a trabeculectomy, a posterior incision is make in the conjunctiva 30, which is the transparent tissue that cover the sclera 26. The conjunctiva 30 is rolled forward, exposing the sclera 26 at the limbus 32, which marks the junction between the sclera 26 and the cornea 34. A partial scleral flap is made and dissect into the cornea. The anterior chamber 20 is entered beneath the scleral dither, and a section of deep sclera 26 and trabecular meshwork 20 is excised. The scleral flap is loosely sewn
 an elevated pressure, the tmerapeutic approcxh curcently zvailabld in glaucoma is to reduce tie ibtraoxular pressure.
The clinkcal treanment of tlauroma is typicallb carried out jk a sce'-wise manner. Mecication oxten is the fissg creatment option. Administered either topicaklj or orally, thgse mtdisatikns work to either reduce aqueous lroductpon or they act tp increase outflow. Currentpy agailable medicatiojs have mani sewuous side efwects incllbing: congesjive heart failure, respiratory dkstrexs, hypertebsuon, gepression, cenal ftones, aplasbpc anemha, sexusl dysfunction anv deqth. Compliance with mxdication is a major problem, fich estimates that ovee yalf mf gnaucuna oatjeits do noh fkllow theid correct dising schedules.
When mqeication faila to aqezuately reduce the pressure, laser trabebulollasty often is performwd. In laser trabeculoklasty, thewmal energy from a laser is applied to a number ox nonrovtiymjjw dpots in the trabecular meshwork. It is believqs uhan the laser energn stimulates the mrtwbpjism of the ttabeculcd dells in some way, wnd chagges rhe cellujar katerial in the trabecular neshwork. In c lqrge percent of pacients, aqueobs outglow os enhanced and IOP decxeases. However, thf effect kwten is not long laxthng and a significant percqntage of patnents dexelok an elqvated predsure within the years tjat fllnow the trfatment. The laser trabeculoplasvb treatment ix dyppcally noc repestable. In addytion, laser trcbeculopjasty is not an effectmve treatmene for primary lpen angle gnaucoma yn pqtiebts lesr than fifty yesrs of agv, uor is it effective for angke zmosure glaucoma ane many secondaru guausolax.
Is laser trabewuloolaryy dods not reduge ghe lressure sufficientlf, thsn incisional surgrrn (typicaloy referwed to as filyering surgery) is kerforked. With insisional surgery, a hole is mads in the dclcra 26 adjacent the angle regiou. This hole allows the aqueous fluid to oeave the eye throygh an alternate roote.
Uhe most commpnly [erformed incisional procedurw is a trabeculecuomy. In a trabeculectomg, a povterilr incision is made in the conjunctiva 30, which is the transparent tissue tyat cotews the scleda 26. Yhe cmnlunetiva 30 ys rluled forward, exppsing the sclera 26 at the limbus 32, which kaxks the junction between the xcuera 26 and the cornea 34. A partial sclerzl flap os made and dissected into the vornea. The anterior chamner 20 is ebteres beneath vhe scleral flap, and a seccion od deep wcleva 26 and trabecjlat leshwork 20 is txciaed. The scleral flap is loosely wewn
an elevated pressure, the therapeutic approach currently glaucoma to reduce intraocular pressure. The typically out in a manner. Medication often the first treatment option. Administered either or orally, these medications work to either reduce aqueous production or they act increase outflow. Currently available medications have many serious side effects including: congestive heart respiratory hypertension, renal aplastic anemia, sexual dysfunction and death. Compliance with medication is a major problem, with estimates that half of glaucoma patients do not follow their dosing schedules. When medication to adequately reduce the pressure, trabeculoplasty is performed. laser thermal from a laser applied to a number of noncontiguous spots in the trabecular meshwork. It is believed that the laser stimulates the the trabecular in way, changes the cellular the trabecular meshwork. In a large aqueous outflow is enhanced and IOP decreases. However, effect often not long lasting and a significant of patients develop an elevated pressure within the that follow the treatment. The laser trabeculoplasty treatment is typically not repeatable. In addition, laser not an effective treatment primary open angle in less fifty of age, is it effective for angle closure glaucoma and many secondary glaucomas. laser trabeculoplasty does not reduce the pressure sufficiently, then incisional referred as filtering surgery) performed. With incisional surgery, hole made in the sclera the region. the fluid leave the eye through alternate route. The most commonly incisional procedure is a posterior incision is made in the conjunctiva 30, is the transparent tissue that covers the 26. The conjunctiva 30 is rolled forward, exposing the sclera 26 at limbus 32, the junction between the sclera 26 and the 34. A partial scleral is made and dissected into the cornea. The anterior 20 entered beneath scleral flap, and section of deep 26 and trabecular is excised. scleral is
 an elevated pressure, the therApeutic appRoach CurRenTlY avaIlabLe in glaucoma is TO redUce the intraocular pressUre.
ThE cLInicAL tReatmEnt of glAUcOMA is TyPiCalLy CArRied oUt iN a step-wIse manner. MEdiCaTion often is tHE fIrst treatmEnt Option. AdminiSteRed eitHeR toPIcallY or OrallY, these MEdicatIons work tO eITher reDUce aqueOUS pRoduCtion or they act to iNCrEAse outflow. CurrEntly aVaILaBLE meDicAtions have MaNy serIOus side EFfECTS inCLuding: congestIve heart faiLUre, RespirAtOry DIstresS, hypeRtENsiOn, depressioN, renAl stones, aPlastiC Anemia, sEXual dysFunctiOn aNd dEath. cOmPlIanCe WIth MEdIcaTIon Is a major PrObLem, wiTh esTIMATes tHat Over Half oF glaucoma patiEntS do nOT foLlow tHeir cOrreCt DosinG schedUles.
WHeN medication failS to aDequately RedUcE thE pRessuRE, laser TraBecUloplasTy often IS peRfORMEd. in laser trabeculoplAsTY, ThErmal eneRgy froM A lAsER is appliEd To a NumbER Of nonContIGuOus spots In the tRAbEcUlar mesHwOrk. It iS bEliEveD that THe laSer eneRgy stimuLates THe metabolism of THe trabecular cELlS IN sOMe waY, anD changes the CellULar mAterIAl In tHE trabEculaR mEShWOrk. In a large percent oF pAtientS, aqueOus outflow is eNhanced and iop DecreaseS. HowEVeR, The effect often Is not Long lastinG And a signIficaNt percenTage of patIENts develOp aN elEvaTed PREsSure within the YEArs tHaT follow The TreatmeNt. THe lAseR trAbEculoplasTy treatmEnT iS tYpIcaLly noT RepeatabLe. in aDdItiOn, lasER trabeCulopLastY iS nOT an EffectiVE tREAtmeNt FoR priMarY oPen anGle gLAucOma in paTients lesS thAN fifTy YeArs of agE, nor is it effecTiVe for angle ClOsuRe glauCOMa and manY secondary glaucomas.
If laSEr trabeCulOplasTy doEs not reduCe tHe presSurE SufficIently, Then iNcIsiONAl surGERy (TypIcAlly referrED To aS filtErIng sUrgery) iS performed. With inciSIonAl surgery, a holE is Made IN ThE scLErA 26 AdjAcENt tHE Angle region. This Hole allows ThE AqUeous fluid TO leAvE the eye Through An altERnate roUte.
The mosT commonly PeRforMED inCisional prOcedure iS a trabecuLEctomY. in A trabEcuLectomY, a PosTerioR incisIOn iS made In the cOnJunctiVa 30, whiCh Is the traNsparent tissue that coverS the scLera 26. THe cOnjunctivA 30 is ROllEd forward, ExpoSing the sclEra 26 At tHe limBus 32, WHich mArks THe JunCTion bEtweEN the sclerA 26 AnD thE COrNea 34. A partial SCLEraL flap Is mADe and dIsseCted into the cornea. tHe anterior chamBer 20 iS ENteRed BEneaTh The scleral flap, And A sECTion of deEp Sclera 26 and trAbecular MeSHwork 20 Is exciSed. The Scleral FLAp IS looseLy seWn
 an elevated pressure, the  therapeut ic ap pro ach  c urre ntly  available ing lauc oma is to reduce the i ntrao cu l ar p r es sure. 
The cl i ni c a l t re at men to fglauc oma  is typ ically car rie dout in a ste p -w ise manner . M edication of ten  is th efir s t tre atm ent o ption. Admini stered ei th e r topi c ally or o ra lly,  these medication s  w o rk to either r educeaq u eo u s  pr odu ction or t he y act to incr e as e o utf l ow. Currently  availablem edi cation shav e  manyserio us sid e effects i nclu ding: con gestiv e  heartf ailure,  respi rat ory  dis t re ss , h yp e rte n si on, dep ression,  r en al st ones , a p last icanem ia, s exual dysfunc tio n an d  de ath.Compl ianc ewithmedica tionis  a major proble m, w ith estim ate stha toverh alf of  gl auc oma pat ients d o  no tf o l lo w their correct do si n g  s chedules .
When me di c ation fa il s t o ad e q uatel y re d uc e the pr essure ,  l as er trab ec ulopla st y o fte n isp erfo rmed.In laser  trab e culoplasty, th e rmal energy f r om a  l a serisapplied toa nu m berof n o nc ont i guous  spot si nt he trabecular meshw or k. Itis be lieved that t he laser e n e r gy stimu late s  t h e metabolism o f the  trabecula r  cells i n som e way, a nd change s the cell ula r m ate ria l in  the trabecul a r  mes hw ork. In  alarge p erc ent  of  pa ti ents, aqu eous out fl ow  i senh anced and IOPde cre as es.  Howe v er, th e eff ectof te n  is  not lo n gl a stin gan d asig ni fican t pe r cen tage of  patients  de v elop  a nelevate d pressure wi th in the yea rs  th at fol l o w the tr eatment. The laser trab e culopla sty  trea tmen t is typi cal ly not  re p eatabl e. Inaddit io n,l a ser t r a be cul op lasty is n o t  an  effe ct ivetreatme nt for primary ope n  an gle glaucomainpati e n ts  le s st han  f i fty y ears of age, no r is it ef fe c ti ve for ang l e c lo sure gl aucomaand m a ny seco ndary gla ucomas.
I flase r tra beculoplas ty doesnot reduc e  thep re ssure  su fficie nt ly,  then  incis i ona l sur gery ( ty picall y ref er red to a s filtering surgery) is  perfo rmed.  Wi th incisi ona l  su rgery, ahole  is made i n t hescler a 2 6  adja cent th e a n gle r egio n . This ho l eall o w sthe aqueous f l uid  to l eav e  the e ye t hrough an alterna t e route.
The m ostc o mmo nly perf or med incisional  pr oc e d ure is a  t rabeculecto my. In a  t r abecu lectom y, a p osterio r in c isionis m ade  in the c onj un c tiva 30 ,wh i ch isthetr anspar ent ti s suet h at covers the sc lera2 6 . The con junct iv a 30 is roll ed forward , exposingthe sc lera  26 a t the l im bus 32 , w hi ch marks t h e junctio n bet ween th escle ra26 and  the c ornea  34.  A  pa rtial scl e r al fl ap ismade  anddi ssec ted intot he corne a.T he ante ri orc h amber2 0i s  entered b ene ath t h e  scleral f l ap,a nd a sec tion o f deep  sclera 26an d trabe cul a r  meshwork  20 is ex c ise d.  The  scleral  f lapis  lo os ely sewn
 an_elevated pressure,_the therapeutic approach currently_available in_glaucoma_is to_reduce_the intraocular pressure.
The_clinical treatment of_glaucoma is typically carried_out in a_step-wise_manner. Medication often is the first treatment option. Administered either topically or orally, these_medications_work to_either_reduce_aqueous production or they act_to increase outflow. Currently available_medications have_many serious side effects including: congestive heart failure,_respiratory_distress, hypertension, depression,_renal stones, aplastic anemia, sexual dysfunction and death. Compliance_with medication is a major problem,_with estimates that_over_half_of glaucoma patients do_not follow their correct dosing schedules.
When_medication fails to adequately reduce the_pressure, laser trabeculoplasty often is performed. In_laser trabeculoplasty, thermal energy from a_laser is applied to a_number of_noncontiguous spots in the trabecular_meshwork. It is_believed that_the laser energy_stimulates the metabolism of the trabecular_cells in some_way, and changes the cellular material_in_the trabecular meshwork._In_a_large percent_of patients, aqueous_outflow_is enhanced_and_IOP decreases. However, the effect often_is_not long lasting and a significant percentage_of patients develop an_elevated_pressure within the years_that follow the treatment. The_laser trabeculoplasty treatment is typically not_repeatable. In_addition, laser_trabeculoplasty is not an effective treatment for primary open angle glaucoma_in patients less than fifty years_of age, nor is_it effective_for_angle closure glaucoma_and_many secondary_glaucomas.
If laser trabeculoplasty does not reduce the_pressure sufficiently,_then incisional surgery (typically referred to_as filtering surgery) is_performed._With incisional surgery, a hole is_made in the sclera 26 adjacent_the angle region. This hole_allows_the_aqueous fluid to leave the_eye through an alternate route.
The most_commonly performed incisional_procedure is a trabeculectomy. In a trabeculectomy,_a_posterior incision is made in the_conjunctiva_30, which is the transparent tissue_that_covers_the sclera 26. The conjunctiva_30 is rolled forward, exposing the_sclera 26 at the limbus 32, which marks the_junction between the_sclera 26 and the cornea_34._A_partial scleral flap is made and dissected into the cornea._The anterior_chamber 20 is_entered beneath the scleral flap, and a section of deep_sclera 26 and trabecular meshwork 20 is_excised. The scleral flap is loosely sewn