Surgical treatment of glaucoma

14/03/2025

Glaucoma is a chronic eye disease that can cause irreversible damage to the optic nerve and vision loss if left uncontrolled.

The initial treatment for glaucoma typically focuses on medication or laser-assisted procedures. However, in advanced or refractory cases, surgery becomes an essential option. There are various surgical techniques available to manage glaucoma, each designed to lower intraocular pressure (IOP), the primary modifiable risk factor for this disease.

Minimally invasive glaucoma surgery (MIGS)

In recent years, less invasive techniques known as MIGS (minimally invasive glaucoma surgery) have been developed. These involve devices designed to create additional drainage pathways or enhance the flow of aqueous humour within the eye’s natural channels. They are quick procedures with lower post-operative risks and shorter recovery times, although they are generally more suitable for mild to moderate glaucoma cases.

Filtration surgery

Filtration surgery (trabeculectomy and non-penetrating deep sclerectomy) is the most widely used technique for advanced and/or uncontrolled glaucoma. It involves creating a drainage channel inside the eye, allowing aqueous humour to exit and accumulate in a subconjunctival "bleb," where it is reabsorbed. This technique has proven effective in reducing IOP.

Drainage implants

Drainage devices are small tubes that divert aqueous humour from inside the eye to an external reservoir implanted under the conjunctiva. They are a versatile option, particularly useful for complex glaucomas or cases where other surgical interventions have not yielded favourable results.

Transscleral cyclophotocoagulation

This technique uses laser energy to partially damage the ciliary body, reducing the production of aqueous humour. It is a useful option in severe cases where other surgical techniques are not considered viable.

The choice of surgical technique depends on the type of glaucoma, the condition of the eye, and the individual characteristics of each patient. While these surgical procedures can be highly effective, they do not eliminate the need for regular follow-up to prevent complications and preserve vision.

Dr Francisco Ruiz Tolosa, ophthalmologist at the Barraquer Ophthalmology Centre