Glaucoma Surgery: What You Need to Know for Treatment Success

Medically reviewed by Christine L. Larsen, MDMedically reviewed by Christine L. Larsen, MD

Various conditions can cause glaucoma and require different treatment approaches. Surgery can target this serious eye condition in various ways. In glaucoma, high intraocular (inside the eye) pressure threatens the optic nerve, which transmits visual information from the eye to the brain.

Currently, there's no cure for glaucoma, but it's possible to slow or possibly prevent vision loss with the aid of surgery, laser, and medication. The use of medication or laser is the more conservative approach, but surgery is the mainstay of treatment when these options don't work.

Learn here about the varying types of glaucoma and the surgical procedures that can work to counter them.

Types of Glaucoma Surgery (and How They Work)

Learn about the options that can help with the type of glaucoma you are experiencing.

Trabeculoplasty

Many people undergo trabeculoplasty for open-angle glaucoma. As it doesn't involve an incision, it is a non-surgical procedure. Trabeculoplasty is considered an appropriate first-line treatment in glaucoma and is often utilized before drops are even started.

In open-angle glaucoma, the fluid inside the eye doesn't drain fast enough, raising eye pressure, which can damage the optic nerve. Trabeculoplasty can help lower eye pressure by increasing drainage.

The approach originally used was argon laser trabeculoplasty (ALT). It involves treating half of the eye's drainage system, known as the trabecular meshwork, by burning tiny laser spots along the perimeter. If this is not sufficient, the other half can be treated. The downside of ALT is that it can cause scarring and can't be repeated.

A somewhat newer approach is selective laser trabeculoplasty (SLT). This uses a lower-powered laser but works in much the same way. However, SLT only targets pigmented cells without disrupting other cells in the meshwork. Because of this, the approach can be repeated, often bringing pressure down by about 20% to 30%.

Glaucoma Implant Surgery (Tube Shunt)

Another way to reduce pressure in the eye is to use a tube shunt. With this approach, the shunt is placed into the eye's anterior chamber to provide an alternative route through which fluid can flow out of the eye and bring pressure down.

This procedure is typically used in cases where conservative measures or trabeculectomy have not been successful. A tube shunt is also the preferred surgical procedure for certain subtypes of glaucoma, such as neovascular glaucoma.

Neovascular glaucoma is a type of secondary angle closure glaucoma in which new blood vessels grow in the iris and/or the anterior chamber angle, and intraocular pressure is increased.

Minimally Invasive Glaucoma Surgery (MIGS)

This approach involves microsurgical procedures that can help lower intraocular pressure without some of the associated risks of more traditional glaucoma surgery. When used in the eye, they work to bring down pressure in various ways.

The ways different devices work include:

• Enhancing the drainage system's ability to work, either through placement of an implant, dilation of the outflow channels, or removal of drainage tissue

• Sending the ocular fluid to the outside of the eye so there's less pressure inside
  

Cyclophotocoagulation (CPC)

With cyclophotocoagulation (CPC), a special laser reduces the amount of fluid produced in the eye by the ciliary body (a ring of muscle around the iris and lens that also produces aqueous humor in the eye).

Since less fluid flows through the eye, there is less strain on the drainage system, which is not functioning properly, and the pressure in the eye comes down.

Laser Peripheral Iridotomy (LPI)

A laser peripheral iridotomy is done when the eye's drainage system becomes blocked and does not allow fluid to flow out in angle-closure glaucoma. This can happen when the colored portion of the eye, the iris, blocks the drainage system.

A laser can create a tiny channel about the size of a pinhole in the iris. This allows fluid to flow to the front of the eye, and the eye pressure, in turn, decreases.

Who May Need Glaucoma Surgery?

Not everyone with glaucoma needs to undergo surgery. Glaucoma can often be managed with less invasive measures such as medication alone. However, for those whose vision appears to be at high risk of substantial sight loss, surgery may enable pressure to be reduced enough to spare vision.

Preparing for Glaucoma Surgery

If you need to undergo glaucoma surgery, you usually will have time to get ready. This may mean having a detailed discussion with your eye doctor about the kinds of medications you're on and why. Some of these may interfere with the potential success of the procedure, while others remain essential.

Before the procedure, your eye doctor may ask you to do the following:

• Refrain from using over-the-counter (OTC) anti-inflammatory products like aspirin.

• Stop taking prescription blood-thinning medications such as warfarin or Plavix (clopidogrel) at least one week before surgery, according to your eye specialist's instructions.

• Make sure you have a ride home after the surgery.

• Don't forget to take any eye medications that don't interfere with the procedure and that are needed to control your glaucoma or other conditions.
  

Recovery and Post-Operative Care

Glaucoma surgery usually allows you to return home just a few hours after the procedure. But keep in mind that the first few days after surgery are very important for your recovery. While you may feel more like your old self, it can take up to six weeks to fully recover.

Your eye will be patched initially after the procedure to protect it from injury and infection. Your eye doctor will give you specific instructions for the procedure you underwent. Once you get home, here's what to expect:

• Your eye doctor will want to see you for a follow-up appointment the next day.

• You'll be instructed to keep the eye from getting wet.

• You may not be able to drive for some time after receiving sedation.

• You'll have to forego activities that may raise eye pressure, such as bending over or lifting anything heavy.

In particular, you may feel some discomfort during the first few days. Your eye doctor may prescribe anti-inflammatory drops every hour or two. They may also suggest taking an OTC medication like Tylenol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) like Advil (ibuprofen) to reduce any pain.

Risks and Complications

In many cases, you will recover without incident from glaucoma surgery. But there may be instances when you experience a complication. Most of the time, any benefits of the surgery outweigh the risks, but still, there can be complications, such as the following:

• Cataract formation (clouding of the lens)

• Postoperative infection

• Eye pressure that's too low (hypotony)

• Scar formation

• Bleeding in the eye

• Loss of vision

Can Glaucoma Be Prevented

Unfortunately, there is no way to prevent glaucoma. However, you can take steps to reduce the risk. Some steps you can take may include:

• Visit your eye doctor regularly to maintain your eye health. They can monitor your eye pressure, check your optic nerve, and more. This is particularly important for those over 65 who should have their eyes checked every couple of years.

• Avoid eye injuries by wearing protective gear for high-risk activities. Those who experience eye trauma are at greater risk of later developing glaucoma.

• You can keep eye pressure down with medication or by exercising, which has also been shown to lower eye pressure.

Alternative Treatment Options

Surgery will likely not be the only treatment option your eye doctor offers. The treatment recommended will depend upon the type and severity of your glaucoma.

Your eye doctor may prescribe drops to help keep your eye pressure in check. This is often the first option recommended in addition to laser trabeculoplasty. Medication can reduce the amount of fluid produced by the eye or dilate blood vessels so fluid can flow out more easily.

You may need to take medication anywhere from one to four times a day. Your eye doctor may try several different ones before they find the best one for you. They may even recommend taking several medications at the same time to lower pressure sufficiently.

If these approaches, either alone or in combination, are not sufficient, surgery may be recommended.

Summary

If you have glaucoma and more conservative approaches, like the use of drops, are not sufficient, your eye doctor may recommend a surgical approach. Surgical approaches work in different ways, from increasing drainage to reducing the fluid produced in the eye. Your eye doctor can help you navigate the options and determine the best approach.

Read the original article on Verywell Health.