Glaucoma Surgery
Glaucoma Eye Surgery at SightMD
If glaucoma medicines and laser treatment haven’t helped to treat your glaucoma, your doctor may recommend surgery. Surgery can’t cure glaucoma or undo vision loss, but it can help protect your vision and stop it from getting worse.
There are a few different types of surgery for glaucoma that can help lower the pressure in your eye:
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- Trabeculectomy
- Glaucoma implant surgery
- Minimally invasive glaucoma surgery (MIGS)
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Traditionally, incisional glaucoma surgery has been reserved for those patients who have more severe disease; however, over the past 10 years, many less risky, less invasive glaucoma procedures have been developed that can benefit patients who have earlier stage glaucoma, especially those patients who also require cataract surgery. In general, glaucoma surgery is performed in ambulatory surgery centers and does not require hospitalization. If you have difficulty tolerating your glaucoma medication or if laser treatment has been unable to adequately control your eye pressure, you may benefit from glaucoma surgery, regardless of the stage of your glaucoma.
What is Trabeculectomy?
This type of surgery is usually used to treat open-angle glaucoma. It’s done in a hospital and usually takes less than an hour.
The surgeon will create a tiny opening in the top of your eye. The opening will be 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.
What is 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 a hospital and usually takes 1 to 2 hours.
In this operation, the surgeon implants a tiny tube, or shunt, onto the white part 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.
What is Minimally Invasive Glaucoma Surgery (MIGS)?
Minimally Invasive Glaucoma Surgery (MIGS) are procedures that 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.
The MIGS group of operations are divided into several categories:
- Miniaturized versions of trabeculectomy
- Trabecular bypass operations
- Totally internal or suprachoroidal shunts
- Milder, gentler versions of laser photocoagulation
Micro Trabeculectomies
Using tiny, microscopic-sized tubes that can be inserted into the eye and drain fluid from inside the eye to underneath the outer membrane of the eye (conjunctiva), two new devices seem to make the trabeculectomy operation safer.
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 tiny incision into the trabecular meshwork under high power microscopic control.
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 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.
New Laser Procedures
Previously, laser cyclophotocoagulation was reserved for advanced glaucoma that could not be controlled despite trabeculectomy or tube shunts. The procedures were designed to reduce the fluid-forming capacity of the eye by targeting the delicate tissue (ciliary body) that makes the fluid. They sometimes produced severe inflammation that could reduce vision. Two recent additions to the laser treatment procedures have proven useful even before the glaucoma is far advanced. These are endocyclophotocoagulation and micropulse cyclophotocoagulation.