Glaucoma Surgery

Laser eye surgery for glaucoma is designed to boost the outflow of fluid from the eye in open-angle glaucoma or to eliminate the fluid blockage in closed-angle glaucoma. There are several types of laser surgery,. including:

• Selective Laser Trabeculoplasty, which is used to treat open-angle glaucoma. The procedure uses a laser that acts at a low energy level, treating specific cells “selectively” to leave the overall structure of the trabecular meshwork intact. Selective laser trabeculoplasty has been successful in lowering eye pressure in up to 70% of patients treated.
• Laser Peripheral Iridotomy, which is used to treat closed-angle glaucoma. Closed-angle or narrow-angle glaucoma occurs when the angle between the iris and the cornea is too small. This causes the iris to block fluid drainage, which, in turn, increases inner eye pressure. During the procedure, a small hole is made in the iris, allowing the fluid drain.

MIGS is a group of glaucoma surgical operations in which microscopic-sized equipment and tiny incisions are used to provide increased safety. Typically, MIGS requires shorter operation time and provides more rapid visual recovery. MIGS has become more popular among eye surgeons in recent years because of its improvements in safety. The tradeoff that comes with lower risk for complications is that we typically see mild to moderate reductions in intraocular pressure with this type of procedure. That’s why MIGs is unlikely to completely replace traditional glaucoma surgery, especially in cases of advanced disease or high pressure that require more aggressive lowering. It is an additional option for surgeons to consider in customizing treatment to the individual patient.

Usually, this type of surgery is restricted to patients with glaucoma that is rampant and getting progressively worse despite an aggressive medication regimen. However, the improved safety profile with MIGS allows doctors to consider surgical treatment of glaucoma earlier in the course of the disease. MIGS procedures are commonly performed in conjunction with cataract surgery, and, in some cases, are only FDA- approved to be completed as such.

When other treatments fail to lower eye pressure adequately, your doctor may recommend filtering surgery. In filtering surgery, a tiny drainage hole is made in the sclera, the white part of the eye. This allows fluid to flow out of the eye and helps to lower eye pressure. Sometimes, a small tube is used to help ensure the opening stays unobstructed long term. This can prevent damage and help to protect the optic nerve. The surgery is usually performed with a local anesthetic, relaxing medications, and a limited type of anesthesia called intravenous sedation. Filtering surgery is usually an outpatient procedure, requiring no overnight hospital stay.

Typically, recovery from glaucoma surgery take longer than other more common eye procedures, such as cataract or LASIK surgery. Your specialist will discuss the expected length of your recovery based on the recommended procedure for your particular situation. The surgery itself is not painful, but you may experience a sore or itchy feeling as you recover. The use of artificial tears, a cool compress, or over the counter pain medication can provide relief.