Glaucoma Surgery : Types, Recovery Expectations, and Treatment Options

Glaucoma surgery is one of the ways to effectively treat glaucoma. However, surgery is not generally the first step that must be taken for treating the condition. However, if other treatments fail to provide relief, surgery can save your eyesight.

In the United States, about 175, 000 glaucoma surgeries were performed in 2020.⁽¹⁾ In this article, we will discuss some of the major types of glaucoma surgeries and also know about recovery expectations.

Glaucoma is a condition in which there is optic nerve damage or the threat of damage because of pressure inside the eye. People who are affected with glaucoma can experience their eyes being over-inflated and the fluid in the eyes cannot be drained out as it should, which in turn can harm vision. Getting a prompt diagnosis can aid in preserving the vision. Thus everyone should attend routine eye examinations.

The Centers for Disease Control and Prevention (CDC) has recommended that everyone above 40 years should have a thorough eye examination to check for glaucoma and other concerns related to eye health.⁽²⁾

In case you are progressing towards the beginning of glaucoma, your eye specialist will prescribe you some eye drops or rarely oral medicine to lower the pressure in your eye. However, if drugs do not work, the next step would be surgery. Sometimes some people might require glaucoma surgery immediately if their eye pressure is high which could put their vision at risk.

Some medicines prescribed for glaucoma can cause severe side effects like rapid heartbeat, high blood pressure, or even impotence. In such cases, you will be advised to go for surgery.

Trabeculectomy is the most common type of glaucoma surgery. This surgery is used for treating open-angle glaucoma, which is a common form of glaucoma and occurs when fluid in the eye cannot be drained properly, thus increasing pressure in the eye.

A trabeculectomy is a major surgical procedure that takes around one hour to complete. It might be done under local or general anesthesia. During this medical procedure, your surgeon will either numb the area or administer general anesthesia. Then an incision will be made in the top of your eye beneath your eyelid to create a channel or ‘bleb”. This channel would drain the excess fluid from your eyes. Then they will place stitches to hold open the channel.

Following this surgical procedure, your surgeon will be placing a patch over your eye, and you can go home. You will have to wear this patch until at least the next day when you will again meet your surgeon for a follow-up appointment. When your eye is ready, mainly around two weeks later, your stitches will be removed.

MIGS is a newer kind of surgery that takes less time to complete (usually just a few minutes) and also has a faster recovery rate when compared with other types of glaucoma surgeries. ⁽³⁾ Minimally invasive glaucoma surgery (MIGS) uses micro-incisions and microscopic-sized equipment that helps in relieving pressure in your eye.

This procedure is used only for mild cases of glaucoma. It has less risk of any sort of complications. However, some experts argue that Minimally Invasive Glaucoma surgery (MIGS) may not be as effective as gold standard procedures of glaucoma surgeries like trabeculectomy and yet there is not enough long-term data on it.⁽⁴⁾

Moreover, the specialized tiny equipment that is required to perform this type of glaucoma surgery is quite expensive, which could be prohibitive for some people.

Another procedure to treat glaucoma is Glaucoma implant surgery, also known as a tube shunt. It would be recommended for you if you have congenital or neovascular glaucoma. However, people with other types of glaucoma can also be benefited from this procedure.

Glaucoma implant surgery can take one or two hours and involves implanting a shunt, or a tiny tube in the affected eye. The shunt implants lower pressure in the eye by allowing extra fluid to drain. This is done typically on an outpatient basis with a local anesthetic. This surgery is usually done under slight sedation. However, occasionally patients might need general anesthesia.

Argon laser trabeculoplasty (ALT) is a form of laser surgery for treating mainly open-angle glaucoma. During the ALT procedure, the patient sits facing the laser machine. The laser “spot” will be applied to a special contact lens that is held on the front of their eyes. As the laser is applied, one can see flashes of green or red light. More fluid can be released from the eye through argon laser trabeculoplasty and this will also relieve some of the pressure on the eyes.

Laser peripheral iridotomy (LPI) is a commonly used laser surgery used to treat narrow-angle glaucoma and also to prevent glaucoma attacks in people with anatomically narrow angles.

When the angle between the cornea and the iris in the eye is too small, it is said to be narrow-angle glaucoma. This can cause the affected person’s iris to plug up so that fluid cannot flow freely and it can lead to a rise in high pressure in the eye.

In laser peripheral iridotomy (LPI), the laser will be used for making a small hole in the iris and this tiny hole will allow fluid to flow more freely within the eye.

Cyclophotocoagulation (CPC) is a type of glaucoma surgery that involves using laser treatment to reduce pressure and fluid production in the eye. However, it’s important to note that there are different techniques and approaches to cyclophotocoagulation, and their invasiveness can vary.

The invasiveness of cyclophotocoagulation depends on the specific method used, such as transscleral or endoscopic cyclophotocoagulation. Transscleral cyclophotocoagulation involves applying laser treatment to the ciliary processes through the sclera (the white outer layer of the eye). This technique is less invasive compared to other procedures that involve direct intraocular access.

On the other hand, endoscopic cyclophotocoagulation is a more invasive technique. It involves using an endoscope to visualize and apply laser treatment directly to the ciliary processes inside the eye. This method provides more precise targeting but requires entering the eye through a small incision, which can be considered more invasive compared to transscleral approaches.

It’s essential to consult with an ophthalmologist or glaucoma specialist who can evaluate your specific condition and determine the most appropriate technique of cyclophotocoagulation based on factors such as the severity of glaucoma, previous treatments, and individual patient characteristics.

Some of the risks and complications involved with glaucoma surgery can include, dryness of the eye, eye pain or discomfort, eye infection, low pressure in the eye, cataracts, and even loss of vision.

Aftercare instructions would differ depending on the procedure that you might have undergone. You should always follow the prescribed care instructions provided by your doctor, attend follow-up appointments, and take the prescribed medications as per your doctor’s directions.

Glaucoma surgery has a high rate of success.⁽⁵⁾ A huge number of patients undergoing the procedure report that they were relieved from the eye pressure after the glaucoma surgery, which improved their overall eye health.

Recovery from glaucoma surgery will be a quite long process. Most patients are healed completely within two to six weeks. In rare cases, it may linger up to several months.

Unlike most laser treatments where you get quick eye recovery, it can take two to six weeks for your eye to recover when you undergo trabeculectomy.⁽⁶⁾

So, during this time you should rest appropriately and that must be your priority. You should allow your eyes to recover for some time and meanwhile, you need to take special care for protecting your eyes from any sort of injury or infection.

Glaucoma treatments like trabeculectomy now require longer time follow-ups because of the long life span.⁽⁷⁾ But again, you should follow the instructions of your doctor or surgeon and go for periodic checkups.

Some of the potential risks and complications associated with glaucoma surgery that might delay recovery time are problems with the cornea, cataracts, loss of vision, failed bleb, eye infection, bleeding inside the eye, and eye pressure that is too low.⁽⁶⁾

If any of these complications arise with or after the glaucoma surgery then it can delay your recovery time. That is why, you should have constant appointments with your surgery following surgery.

Some of the precautions that must be followed after glaucoma surgery for a faster recovery are as follows.

• Do not rub or scratch your eyes: You might have blurry vision for a few days after glaucoma surgery. You might also feel like your eye is itchy. You should however, resist the temptation and not rub or scratch the eyes.
• Take all prescribed eye drops: Eye drops can help soothe the itchiness in your eyes and avoid eye infections. So, use the prescribed eye drops.
• Avoid heavy lifting: You should also avoid lifting heavy weights, straining, and bending for the first two weeks following the glaucoma surgery until you are healed completely.
• Avoid going to swimming pools: Swimming pools are breeding grounds for infection-cause bacteria. So, you should avoid swimming pools after glaucoma surgery at least for a few weeks or months to recover quickly.

Glaucoma surgery is a treatment procedure that can stabilize vision and also prevent vision loss, especially when other forms of treatment are unsuccessful. Though there are various types of surgery for glaucoma, trabeculectomy is the most common one.

If you have undergone glaucoma surgery you should take the necessary precautions and visit your doctor for follow-ups. You might be prescribed postoperative antibiotics or steroid eye drops by your doctor and you would also be prescribed anti-glaucoma medications on an ongoing basis. Apart from all these, you should also take additional steps like wearing protective eyewear, which will help in managing glaucoma and having a quick recovery from the surgery.

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Also Read:

• Glaucoma: Causes, Types, Signs, Treatment- Surgery, Laser, Filtering, Drainage Implants
• How Can You Avoid Getting Glaucoma?
• Is Glaucoma Serious?
• How Does Glaucoma Affect Your Vision?
• How Long Does It Take To Go Blind From Glaucoma?
• Can Glaucoma be Stopped?
• What Can Happen if You Have Glaucoma?