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Glaucoma surgery is a group of procedures that help lower eye pressure, also known as intraocular pressure (IOP). These surgeries are considered when eye drops, medications, or laser treatments are not enough to control pressure. Lowering eye pressure helps protect the optic nerve and can slow or prevent further vision loss.
Glaucoma surgery cannot restore lost vision, but it can help preserve your remaining sight.
This is why early diagnosis and proper treatment are so important.
Why Surgery Is Sometimes Needed
In a healthy eye, a clear fluid called aqueous humor moves in and out of the eye without problems.
With glaucoma, this fluid does not drain as it should, or the eye makes too much fluid. This causes high eye pressure.
With glaucoma, this fluid does not drain as it should, or the eye makes too much fluid. This causes high eye pressure.
If the pressure stays high, it can damage the optic nerve. The optic nerve sends visual signals from your eye to your brain. Over time, this damage can cause permanent vision loss.
Surgery is recommended when:
- Eye drops or medications are not working well enough.
- Laser treatments have not controlled pressure.
- The optic nerve continues showing damage.
- The patient cannot tolerate or afford long-term medications.
- Pressure must be lowered quickly to prevent further vision loss.
Types of Glaucoma Surgery
There are several types of glaucoma surgery. Your eye doctor will recommend the best option for you based on the type of glaucoma you have, your eye pressure, and your overall eye health.
Here is a summary of the most common glaucoma surgeries.
1. Trabeculectomy (Filtering Surgery)
Trabeculectomy is a well-known glaucoma surgery. The surgeon creates a small flap in the white part of the eye, known as the sclera. This lets fluid drain into a small pocket, called a bleb, under the eyelid. The fluid bypasses the eye’s usual drainage system.
This helps lower eye pressure by letting fluid leave the eye more easily.
Best for:
- If you have moderate to advanced glaucoma, trabeculectomy is often a top choice. This surgery is ideal for people who haven’t had success with medications or laser treatments. It’s a proven approach when you need a more effective solution to lower eye pressure and protect your vision.
2. Glaucoma Drainage Devices (Tube Shunts / Setons)
For this surgery, the doctor places a small tube or implant inside the eye.
The tube moves fluid to a small plate under the eyelid. The body then absorbs the fluid naturally.
The tube moves fluid to a small plate under the eyelid. The body then absorbs the fluid naturally.
Doctors often use these devices if trabeculectomy has not been successful or if you have had multiple previous eye surgeries.
The most common glaucoma drainage devices you might hear about in your eye doctor’s office:
Ahmed Valve: This device utilizes a specialized valve to regulate the flow of fluid out of the eye, thereby preventing pressure from dropping too low.
Baerveldt Shunt: The Baerveldt shunt doesn’t have a valve, allowing fluid to drain more freely, which can be beneficial for more severe cases of glaucoma.
Molteno Implant: One of the original tube shunt designs, the Molteno is still used today for patients who need long-term pressure control.
Each of these devices has its own strengths, and your eye doctor will help you select the one that best fits your unique needs.
Best for:
- Glaucoma drainage devices are mainly recommended for those with advanced glaucoma, especially if your eye’s drainage tissue is scarred or you’ve had previous surgeries that didn’t work out. If you’re running out of options, these devices can be a game-changer, offering another route to keep your eye pressure under control.
3. MIGS (Minimally Invasive Glaucoma Surgery)
MIGS stands for minimally invasive glaucoma surgery. These are newer procedures that lower eye pressure with less trauma to the eye and a quicker recovery.
MIGS uses tiny stents, small tubes, or laser-created channels to help fluid drain from the eye.
Benefits of MIGS:
- Smaller incisio: This often means that most people can resume desk work or light activities within three days, offering minimal disruption to daily life.
- Faster healing: Many patients find they can return to their regular routines sooner, allowing for a swift transition back to daily tasks and responsibilities.
- Fewer complications: With fewer risks, patients often experience less anxiety about post-operative issues, leading to a smoother recovery process.
- Can be performed during cataract surgery: For those already planning cataract surgery, combining it with MIGS can mean fewer surgeries and a more convenient recovery schedule.y
Common MIGS procedures:
iStent / Hydrus Microstent | Places a tiny implant to help fluid drain into Schlemm’s canal |
Kahook Dual Blade | Removes part of the trabecular meshwork to improve flow |
OMNI Surgical System | Opens drainage channels microscopically |
Trabectome | Uses microelectrocautery to remove clogged drainage tissue |
Best for:
- MIGS procedures are a good choice if you have mild to moderate open-angle glaucoma and want a less invasive option. They are also helpful if you are having cataract surgery or want to reduce or stop using daily eye drops.
MIGS is now often the first surgery doctors recommend for people with glaucoma, especially if a faster recovery is important.
4. Laser Trabeculoplasty
Laser trabeculoplasty utilizes a laser to enhance fluid drainage through the eye’s natural drainage system.
The most common type is called SLT, which stands for selective laser trabeculoplasty.
The most common type is called SLT, which stands for selective laser trabeculoplasty.
Advantages of SLT:
- Low risk
- Performed in the office
- Can reduce or eliminate the need for drops
Doctors often use SLT before other surgeries or when adjusting medications.
5. Cyclophotocoagulation (CPC) / Cycloablation
This surgery treats the ciliary body, which is the part of the eye responsible for producing fluid.
By reducing the amount of fluid the eye produces, this surgery helps lower eye pressure.
By reducing the amount of fluid the eye produces, this surgery helps lower eye pressure.
Newer methods, such as micropulse CPC, are gentler and cause fewer side effects.
Best for:
- Cyclophotocoagulation is typically reserved for those battling advanced glaucoma, especially if other surgeries haven’t delivered the desired results. If your glaucoma is stubborn or your eye hasn’t responded to previous procedures, this laser approach might be your next best step.
Benefits of Glaucoma Surgery
- Lowers intraocular pressure
- Helps preserve remaining vision
- May reduce or eliminate the need for daily medications
- Can offer long-term control of glaucoma
- Improves daily comfort and visual stability
It is important to understand that glaucoma surgery does not cure the disease or restore lost vision.
The primary goal is to prevent further vision loss.
Risks and Possible Complications
Like any surgery, glaucoma surgery has some risks. These can include:
- Infection
- Bleeding
- Scarring at the surgical site
- Too much or too little pressure after surgery
- Cataract formation
- Need for additional surgery.
Your eye doctor will discuss which risks are relevant to your situation.
What to Expect Before Surgery
Your eye doctor may recommend:
- Stopping certain medications
- Starting antibiotic or anti-inflammatory drops
- Arranging for someone to drive you home
- Taking time off work for recovery
Make sure to discuss:
- Your medical history
- Any medications or supplements you take
- Any concerns or lifestyle needs you have
Recovery After Glaucoma Surgery
Recovery time after glaucoma surgery varies depending on the procedure. Some patients recover within days, while others may need several weeks. Your eye doctor will provide a personalized recovery timeline tailored to your specific situation.
MIGS | Several days to 2–3 weeks |
Laser Trabeculoplasty (SLT) | 24–72 hours |
Trabeculectomy | 4–8 weeks |
Tube Shunts | 6–10 weeks |
CPC / Micropulse CPC | Several days to several weeks |
You may need:
- Prescription eye drops
- Follow-up pressure checks
- Activity restrictions
- Sunglasses protection
Contact your eye doctor immediately if you experience any of the following:
- Sudden vision loss
- Severe pain
- Redness or discharge
Cost of Glaucoma Surgery
The cost of glaucoma surgery varies depending on several factors, including:
- Procedure type
- Surgeon experience
- Clinic or hospital fees
- Insurance coverage
In the U.S., typical costs:
- Trabeculectomy: $5,000–$15,000 per eye
- Tube shunt surgery: $7,000–$20,000 per eye
- MIGS: $2,000–$6,000 per eye
Most insurance plans, including Medicare and national health systems, provide coverage for glaucoma surgery.
Key Takeaways
- Glaucoma surgery is an important step in preventing further vision loss.
- MIGS is now a common first choice for surgery due to its safety and faster recovery.
- The most suitable surgery depends on your type and stage of glaucoma.
- Early diagnosis and regular checkups are essential for protecting your vision.
Frequently Asked Questions (FAQ)
1. Does glaucoma surgery improve vision?
Glaucoma surgery cannot restore lost vision. Its primary goal is to lower eye pressure and protect remaining vision.
2. How long does glaucoma surgery last?
Results vary. Procedures such as trabeculectomy or tube shunts can last many years. MIGS may provide pressure control for several years, especially when combined with cataract surgery.
Results vary. Procedures such as trabeculectomy or tube shunts can last many years. MIGS may provide pressure control for several years, especially when combined with cataract surgery.
3. Is glaucoma surgery painful?
Most patients experience little to no pain during surgery due to numbing. Mild irritation or scratchiness may occur afterward but usually resolves within a few days.
Most patients experience little to no pain during surgery due to numbing. Mild irritation or scratchiness may occur afterward but usually resolves within a few days.
4. How long does recovery take after glaucoma surgery?
Recovery may take a few days for MIGS or SLT, or up to 6 to 8 weeks for trabeculectomy or tube shunt surgery. Your eye doctor will advise when it is safe to resume normal activities.
5. Will I still need eye drops after surgery?
Some patients require fewer or no eye drops after surgery, especially following MIGS. Others may still need medication. Your eye doctor will monitor your eye pressure and advise on the continued use of drops.
Some patients require fewer or no eye drops after surgery, especially following MIGS. Others may still need medication. Your eye doctor will monitor your eye pressure and advise on the continued use of drops.
