Glaucoma is a disease that can lead to visual disability and blindness if not treated properly. It is due to progressive damage to the optic nerve. Today, lowering the eye pressure is the only known way of treating glaucoma. While eye drops and laser treatments are often the first steps, surgery is sometimes needed. There are many types of surgical interventions. Two common types of surgery are trabeculectomy and trabeculotomy. Learn about these two methods, who they’re best for, what recovery looks like, and what long-term results you can expect.*

Main Differences Between Trabeculectomy and Trabeculotomy

Trabeculectomy is a more invasive procedure. Surgeons create a flap, similar to a safety valve, in the white part of the eye and create a drainage pocket, or “bleb”. Fluid goes from inside the eye, through the safety valve, into the bleb.

Trabeculotomy takes a gentler, less invasive route. An instrument is placed in the eye that opens the trabecular meshwork (TM) to help fluid drain more naturally. The TM is the area inside your eye that acts as a sieve to filter the fluid as it leaves the eye. Many instruments may be used to create this opening. Some are:

• Trabectome, 
• Kahook Dual Blade (KDB), and 
• GATT. 

Who Should Get Each Procedure

Trabeculectomy is often used for patients with advanced glaucoma who need a major drop in eye pressure. It’s also used when other treatments haven’t worked. It has a better chance of lower and consistently low eye pressures. It comes with slightly higher risks, however, including but not limited to:

• Longer healing time to regain full vision,
• A greater chance of cataract, and
• An eye pressure that is too low.

Trabeculotomy may be best for people with mild to moderate glaucoma. Both trabeculotomy and trabeculectomy can be done during cataract surgery, which is convenient for older adults. Like trabeculectomy, trabeculotomy has potential drawbacks such as:

• Cataract,
• Bleeding within the eye, and
• A resulting eye pressure that is either too low or not low enough. 

Recovery and Long-Term Results

After trabeculectomy, recovery can take weeks. Patients need to visit the eye doctor often and use several medications to prevent infection or scarring. The success rate is higher, around 60% to 79% at five years, but complications are more common.

Trabeculotomy has a faster and easier recovery. Most patients only deal with some bleeding in the front of the eye (hyphema), which usually goes away on its own. Long-term success depends on the type: GATT and KDB have success rates up to 85–90% at two years in many cases, though some people may still need more treatment or a second surgery later.

In short, trabeculectomy has a better chance of lowering eye pressures that persist. It also has a greater chance of eliminating the need to take eye drops to lower pressure, while trabeculotomy is slightly safer with a shorter recovery. Speak with your doctor about which treatment options might be best for your unique situation.

*Miguel, A., Capitena Young, C., Esfandiari, H., Poat, J. K., et al. (2024, December 2). Ab Interno Trabeculectomy and Trabeculotomy. EyeWiki, American Academy of Ophthalmology. https://eyewiki.org/Ab_Interno_Trabeculectomy_and_Trabeculotomy 

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