Ophthalmologists typically choose eye drops and other medications as a first-line approach for treating glaucoma. These are intended to improve fluid outflow from the eye and lower eye pressure to protect the optic nerve from further damage. Medications aren’t always adequate, though, and surgery may be advised depending on which other treatments you’ve tried, the severity of your glaucoma, and whether or not you have concurrent eye problems or other medical conditions. Here is a brief overview of the four most common types of glaucoma surgery, including their possible risks and what the recovery process looks like.*

Laser surgery

Laser surgeries now play an important role in treating glaucoma and other eye issues, explains the Glaucoma Research Foundation (GRF). Several kinds of laser surgery are available,  depending on the form of glaucoma you have and how advanced it is.

• Selective laser trabeculoplasty (SLT) is used for treating primary open-angle glaucoma (POAG). A very low-level laser selectively treats certain parts of the eye’s natural drainage system, the trabecular meshwork, allowing for better fluid outflow, leaving untreated cells intact.
• Argon laser trabeculoplasty (ALT) is also used to treat POAG. Like SLT, ALT opens channels in the eye’s drainage system to improve fluid outflow.
• Laser peripheral iridotomy (LPI) is used for treating narrow angles and angle-closure glaucoma, where the angle between the cornea and iris is too small, impeding drainage and raising pressure. In LPI, a tiny hole is made in the iris to allow fluid to drain.
• Laser cyclophotocoagulation (CPC) is usually considered as a late alternative to drainage treatments. CPC lowers eye pressure by instead reducing the eye’s ability to produce fluid. Repeat procedures are sometimes necessary.

Risks of laser surgery include temporary increase in eye pressure, too large a decrease in eye pressure, and cataract development. 

Recovery from laser surgery is usually quick, enabling patients to return to normal activity the following day. Laser surgery is most often done in-office, and eye-numbing medicine is applied before surgery. GRF says you may have slight eye irritation and blurred vision after surgery, and should plan on having someone drive you home.

Trabeculectomy

Trabeculectomy is used to treat POAG and is a major procedure, taking about an hour to complete. You’ll either have local anesthesia and be awake for the procedure or have general anesthesia and be asleep.

• An incision is made in the eye underneath the upper eyelid, creating a drainage channel, or “bleb,” to improve fluid outflow. Stitches are used to keep the bleb open.
• After surgery, you can go home with an eye patch that is worn at least through your follow-up the next day. Stitches are removed after about two weeks.

Tube shunt surgery

Surgically implanting a tiny tube, or shunt, inside the eye may be advised for neovascular or congenital glaucoma, as well as for other types of glaucoma.

• The drainage device diverts excess fluid from the eye.
• Surgery is usually performed as an outpatient procedure with local anesthesia and light sedation.

Minimally invasive glaucoma surgery (MIGS)

MIGS is a newer surgery that involves tiny incisions and micro-stents to lower eye pressure. It often takes only minutes to complete and offers faster recovery than conventional glaucoma surgeries.

• MIGS is typically reserved for mild glaucoma cases, but is becoming increasingly popular and available.
• Despite its advantages, some experts believe it’s not as effective as trabeculectomy or other “gold standard” glaucoma surgeries, and that more data is needed.

MIGS can also be cost-prohibitive when not covered by insurance.

What are potential risks and complications?

Post-surgical eye swelling and soreness can take several weeks to heal. Additionally, possible complications can include:

• Dry eye
• Eye pain
• Infection
• Eye pressure that’s too low
• Vision loss
• Cataracts

Not a cure

Early diagnosis and treatment of glaucoma are vital to achieving the best outcomes. People with glaucoma are advised to closely monitor themselves for any vision changes and to adhere to regular eye exams. Be sure to mention any new symptoms to your doctor.

Glaucoma surgery is considered safe and effective for managing vision loss, but it’s not a cure. 

*Iftikhar, N. (2022, September 2). Glaucoma Surgery: Types, Complications, and Recovery. Healthline. https://www.healthline.com/health/eye-health/what-types-of-glaucoma-surgery-are-there