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Glaucoma Surgery

Trabeculectomy

This type of surgery is usually used to treat open-angle glaucoma. It’s done in an operating room and usually takes less than an hour. The surgeon will create a tiny opening in the top of your eye, under your eyelid where no one will see it. This opening allows extra fluid in your eye to drain away, lowering pressure in your eye. Usually, you’ll be awake during this surgery — but you’ll get numbing medicine and medicine to help you relax. You can usually go home the same day, but you’ll need someone to drive you home.

Glaucoma Implant Surgery

This type of surgery is used to treat several types of glaucoma, including congenital glaucoma, neovascular glaucoma, and glaucoma caused by an injury. It’s done in an operating room and usually takes 1 to 2 hours. In this operation, the surgeon implants a tiny tube, or shunt, onto the white of your eye. The tube helps extra fluid drain out of your eye, lowering your eye pressure. Usually, you’ll be awake during this surgery — but you’ll get numbing medicine and medicine to help you relax. You can usually go home the same day, but you’ll need someone to drive you home.

Minimally Invasive Glaucoma Surgery (MIGS)

If you have mild glaucoma, your doctor may recommend a new approach called minimally invasive glaucoma surgery (MIGS). This also lowers eye pressure but it’s safer and helps you recover faster. The MIGS group of operations have been developed in recent years to reduce some of the complications of most standard glaucoma surgeries. MIGS procedures work by using microscopic-sized equipment and tiny incisions. While they reduce the incidence of complications, some degree of effectiveness is also traded for the increased safety. There are different types of MIGS, so ask your eye doctor about whether MIGS may be an option for you.

Microtrabeculectomies
These surgeries function like trabeculectomies and drain fluid from inside the eye to underneath the outer membrane of the eye (conjunctiva). Devices like the Xen Gel Stent seem to make the trabeculectomy operation safer while giving excellent pressure lowering.

Trabecular Surgery
Most of the restriction to fluid drainage from the eye rests in the trabecular meshwork. Several operations have been devised using tiny equipment and devices to cut through the trabecular meshwork without damaging any other tissues in the ocular drainage pathway. Using a special contact lens on the eye, a tiny device is inserted into the eye through a small incision into the trabecular meshwork under microscopic control. The trabecular meshwork can either be destroyed (Trabectome, Trab360) or bypassed using a tiny snorkel-like device (iStent, iStent inject). These procedures are FDA-approved but generally don’t get the eye pressure very low so are most useful in early to moderate stages of glaucoma.

Suprachoroidal Shunts
Using tiny tubes with very small internal openings, the front of the eye is connected to the suprachoroidal space between the retina and the wall of the eye (Glaukos shunts) to augment the drainage of fluid from the eye. This operation has relatively few serious complications and lowers pressures enough to be useful even in moderately severe glaucoma. (2018 update: See note below regarding the CyPass Micro-Stent).

What happens after surgery?

  • You will need to use eye drops to help prevent swelling and infections, and you’ll need to use them for several weeks.
  • You may still need to use some of your glaucoma eye drops.
  • You may need to avoid some activities for 2 to 4 weeks, like lifting anything heavy.
  • You’ll also need check-ups with your doctor to make sure your eye is healing well.

Will I need surgery again?

For some people, the benefits of surgery last a long time. For others, the opening in the eye begins to close up and they need surgery again. You’ll need regular check-ups with your doctor to test your eye pressure. That way, your doctor will be able to act fast if you need more treatment.

What are the side effects of Glaucoma Surgery?

Glaucoma surgery can have side effect s, just like any operation. For example, your eye may be swollen and sore for a while.
Other possible risks include:

  • Cataract
  • Problems with the cornea (the clear surface layer of your eye)
  • Eye pressure that’s too low
  • Vision loss

Talk over the pros and cons of surgery with your doctor. Together, you can make a treatment plan that’s right for you.