Glaucoma is a condition that can cause a person to develop vision loss or blindness. Currently, there is no cure for glaucoma. However, surgery can help to stop it progressing.

Glaucoma can occur when fluid builds up inside a person’s eye. This puts pressure on the optic nerve, which can damage it.

Damage resulting from glaucoma is irreversible. However, there are surgical treatments that can protect vision and prevent it from getting worse.

Read on to learn more about the types of surgeries doctors use to treat glaucoma, as well as recovery and the possibility of additional surgeries.

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A trabeculectomy is a form of surgery that helps to reduce pressure inside a person’s eye.

During the procedure, a surgeon makes a small flap in a person’s sclera — the white part of the eye. The surgeon then creates a tiny hole under the flap. Aqueous fluid drains through this hole, lowering pressure in the eye.

Aqueous humor is a fluid in the eye that provides it with nourishment and helps it to remain inflated. Typically, this fluid fills the eye at the same rate as it drains off, maintaining a constant pressure. Glaucoma occurs when this pressure is too high.

Following a trabeculectomy, the fluid that drains from the eye goes into a small pocket, known as a filtration bleb, in the conjunctiva. The conjunctiva is the outer layer of the eye. From here, the tissues around the eye absorb the excess fluid.

Evidence suggests that trabeculectomy is often the best way to treat glaucoma and is an effective option for reducing pressure in the eye.

Side effects

Although unlikely to cause serious complications, possible side effects of a trabeculectomy include:

  • infection
  • bleeding inside the eye
  • loss of vision
  • eye pressure that is too low
  • discomfort due to a large bleb
  • increasing redness of the eye
  • cataracts

Glaucoma implant surgery involves a surgeon inserting a small device into a person’s eye. This device, known as a glaucoma drainage implant, drains away excess fluid. The device usually consists of a soft, flexible tube that connects to a thin plate. This helps to reduce eye pressure.

During glaucoma implant surgery, a surgeon creates a small pocket under the conjunctiva. The plate of the implant inserts into this pocket, where it sits on the sclera.

The surgeon then inserts the thin tube of the implant into the front part of the eye. Excess fluid drains through this tube and into the plate. The body can then absorb the excess fluid.

Research from 2019 notes that glaucoma implant surgery is effective at controlling glaucoma over long periods. Researchers note that the success rate of the Baerveldt Glaucoma Implant can vary from 43–100%. The Ahmed Glaucoma Valve has a success rate of 68–100%.

Side effects

Possible side effects of glaucoma implant surgery include:

  • scarring in or on the eyeball
  • infection
  • bleeding
  • eye pressure that is too low
  • vision loss
  • cataracts
  • double vision

MIGS is a form of glaucoma treatment that helps reduce a person’s eye pressure using minimally invasive techniques. This treatment is generally safer and causes fewer complications than other glaucoma surgeries. However, it can also be less effective.

There are various types of MIGS treatments available, such as:

Trabectome

A trabectome is an electronic device that doctors use to remove part of the trabecular meshwork. The trabecular meshwork is a spongy area near the cornea. Aqueous fluid drains out of the eye via the drainage angle on the trabecular meshwork.

A surgeon uses the trabectome to remove a strip of the trabecular meshwork. The trabectome also removes the inner wall of Schlemm’s canal, which drains aqueous humor from the eye into the bloodstream. By removing these tissues, the surgeon allows fluid to drain directly into Schlemm’s canal.

iStent

An iStent is a tiny device that allows fluid to bypass the trabecular meshwork. Surgeons insert the iStent into the trabecular meshwork, which allows fluid to drain straight into Schlemm’s canal.

Xen

Xen surgery is similar to a trabeculectomy. However, instead of cutting a flap in the sclera, a surgeon uses a needle to implant a thin, flexible tube into the conjunctiva.

Recovery from glaucoma surgery can vary depending on the type of surgery a person has.

It can take 2–6 weeks for a person’s eye to heal following a trabeculectomy.

After having glaucoma implant surgery, a person may need to wear an eye patch overnight. They can experience blurred vision for days or weeks after surgery.

Following surgery, a doctor may prescribe a person with anti-inflammatory eye drops. A person may need to use these drops every 1–2 hours for the first few days after surgery. They can then reduce this to 4–6 times a day. A person can use these drops for 2–3 months.

During recovery from glaucoma surgery, a person should also:

  • keep their face clean and avoid touching their eye
  • wash hands before using any eye drops
  • use pain medication as necessary
  • avoid bending over, straining, or lifting heavy objects
  • visit their doctor frequently in the weeks after surgery

A person may require additional surgery after their initial glaucoma surgery. This can occur if a person’s eye pressure does not decrease enough.

A person may also need further surgeries if they have a bleb leak or an abnormal amount of fluid in the suprachoroidal space. The suprachoroidal space is the area between the sclera and the choroid. The choroid is the tissue between the sclera and the retina.

There are various surgeries a surgeon can use to treat glaucoma. While these options cannot cure glaucoma or undo vision loss, they can help to protect vision and stop it from getting worse.

Typically, these surgeries work by allowing the eye to drain excess fluid, which helps to reduce pressure in the eye. A person can speak with their doctor about the surgery that is right for them.