When surgery is considered
Surgical treatment is typically recommended when intraocular pressure remains above the target level despite appropriate medical management, or when there is evidence of ongoing optic nerve damage.
It may also be considered in cases where medication is not well tolerated or where long-term control cannot be reliably achieved with non-surgical approaches.
Goals of surgical treatment
The primary goal of surgery is to reduce intraocular pressure to a level that minimises further damage to the optic nerve.
This is achieved by either improving the drainage of fluid from the eye or reducing the amount of fluid produced. The choice of approach depends on the type of glaucoma and the individual characteristics of the eye.
Types of glaucoma surgery
Trabeculectomy
Trabeculectomy is one of the most established surgical procedures for lowering intraocular pressure. It involves creating a controlled drainage pathway that allows fluid to exit the eye more effectively.
This procedure is often used in cases where significant pressure reduction is required or where other treatments have not been sufficient.
Shows how a trabeculectomy procedure can help reduce pressure caused by glacuoma by giving fluid an alternate path from which to exit the eye.Glaucoma drainage devices (tube shunts)
Drainage devices, also known as tube shunts, are used to direct fluid from inside the eye to a reservoir located beneath the outer layers of the eye.
These are typically considered in more complex cases or where previous surgical procedures have not achieved the desired outcome.
Describes the use of a Shunt as a treatment for Glaucoma.Minimally invasive glaucoma surgery (MIGS)
Minimally invasive techniques aim to improve fluid outflow using smaller incisions and less disruption to the eye’s structure. These procedures are often associated with faster recovery times and a lower risk profile.
They are generally considered in earlier stages or in combination with other procedures.
How a new wave of glaucoma surgeries effectively reduce intraocular pressure by creating a new pathway for aqueous fluid to drain. Special thanks to Dr. Devesh Varma of Prism Eye Institute, Candace Miller and the team at Ludwick Eye Center, and Dr. Nathan Kerr for lending their expertise on this topic.Cyclodestructive procedures
These procedures reduce intraocular pressure by decreasing the production of aqueous humour. They are typically reserved for cases where other surgical options are not suitable or have not been effective.
Surgical approach based on glaucoma type
Primary open-angle glaucoma
Surgical intervention may be considered when intraocular pressure is not adequately controlled with medication. Options may include trabeculectomy, drainage devices or minimally invasive procedures depending on severity and response to treatment.
Normal-pressure glaucoma
Although pressure may be within the normal range, surgery may still be considered if there is evidence of progression. The goal is to achieve further pressure reduction to protect the optic nerve.
Narrow-angle (angle-closure risk)
Surgical management focuses on relieving anatomical crowding and improving fluid flow. In some cases, procedures may be required if pressure remains elevated despite initial treatment.
Acute angle-closure
Urgent intervention may be required to control pressure and prevent further damage. Once stabilised, additional procedures may be considered to prevent recurrence and maintain long-term control.
Secondary glaucoma
The surgical approach depends on the underlying cause. In some cases, more complex procedures or drainage devices may be required to achieve adequate pressure control.
Juvenile glaucoma
This form often requires earlier surgical intervention due to its potential for progression. The choice of procedure depends on severity and individual anatomical factors.
Expected outcomes
The effectiveness of surgery varies depending on the type of glaucoma, the severity of the condition and individual response.
The aim is to achieve sustained pressure reduction and reduce the risk of further optic nerve damage. In some cases, additional procedures or ongoing treatment may still be required.
Recovery and follow-up
Recovery following glaucoma surgery varies depending on the procedure performed. Close follow-up is essential to monitor healing, assess pressure control and detect any complications.
Ongoing monitoring remains important, as glaucoma is a chronic condition.
Risks and considerations
As with any surgical procedure, there are risks associated with glaucoma surgery. These may include infection, inflammation, changes in eye pressure or the need for additional treatment.
Careful assessment and planning help minimise these risks and optimise outcomes.
Long-term management
Surgery is one part of long-term glaucoma management. Even after successful treatment, regular monitoring is required to ensure that intraocular pressure remains controlled and that no further progression occurs.