Glaucoma surgery lowers the pressure inside of your eye. This helps to prevent loss of vision. While glaucoma surgery saves remaining vision, it can’t improve sight.
Do I Need Glaucoma Surgery?
In glaucoma patients, the fluid in the eye builds up, causing pressure that damages the eye and causes a loss of vision. If your doctor has already tried less invasive options that didn’t work, then surgery is the best way to preserve your remaining vision.
What Can I Expect During Glaucoma Surgery?
Prior to Procedure
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Aspirin or other anti-inflammatory drugs
- Blood thinners, such as clopidogrel (Plavix) or warfarin (Coumadin)
- Continue to use your eye drops, unless directed otherwise by your doctor.
- Arrange for a ride to and from the procedure.
Description of the Procedure
Drops are used to numb the eye for the procedure. Local anesthesia and sedation may be used for incisional surgery. There are two common types of glaucoma surgery: laser and incisional.
The main types of laser surgery include:
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Argon Laser Trabeculoplasty (ALT)
Argon laser trabeculoplasty (ALT) is the most common type of laser surgery. It's usually used to treat open angle glaucoma. During this procedure, you will sit facing the laser machine. The laser "spot" will be applied to a special contact lens held on the front of the eye. You may see flashes of red or green light as the laser is applied. This procedure will allow more fluid to be released and relieve some of the pressure.
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Selective Laser Trabeculoplasty (SLT)
The procedure is similar to ALT. SLT has the benefit of being repeatable. ALT cannot be done more than twice.
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Laser Peripheral Iridotomy (LPI)
Laser peripheral iridotomy (LPI) is frequently used to treat narrow-angle glaucoma or to prevent glaucoma attacks in patients with anatomically narrow angles. Narrow-angle glaucoma occurs when the angle between the cornea (the clear structure on the front of the eye) and the iris (the colored part of the eye) is too small. This can cause the iris to plug up so that fluid cannot flow freely. This can cause the pressure to rise to dangerously high levels very quickly. In LPI, the laser will be used to make a small hole in the iris. The hole will allow fluid to flow more freely within the eye.
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Cyclophotocoagulation
Cyclophotocoagulation is used to freeze the parts of the eye that make the eye fluid. This procedure is usually done only in people who have severe damage from glaucoma and for whom other surgeries were not successful. Instead of freezing, this procedure can also be done with a laser.
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Incisional Surgery (also known as Filtering Surgery)
This surgery uses tiny instruments to remove a piece from the wall of the eye. This creates a small hole, which is covered by conjunctiva (layer around the eye). The fluid can now drain out through the hole. It will then be reabsorbed into the bloodstream. This reduces the pressure in the eye. In some cases, the doctor may place a valve in the eye through a tiny incision.
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Glaucoma Implants
If the above methods fail, another option is the use of implants. With implant surgery, most of the device is positioned on the outside of the eye. A small tube or filament is carefully inserted into the front chamber of the eye. The fluid drains through the tube, or along the filament, into the area around the back end of the implant. The fluid collects here and is reabsorbed. This procedure is slightly more risky than standard trabeculoplasty and should only be performed by doctors well-versed in the technique.
Glaucoma Surgery FAQs
Here are some of our patients most frequently asked questions about glaucoma surgery.
How Long Does Glaucoma SurgeryTake?
Procedures usually take less than one hour. People having the incisional procedure may need about 4-8 hours from the time of arrival until discharge.
Are There Any Risks?
All surgery carries some risks. Some of the complications from glaucoma surgery include:
- Sensitivity to light
- Infection
- Long-term irritation and inflammation of the eye
- Bleeding
- Loss of vision
- Need for more surgery
You are at higher risk for complications if you smoke or have any of these conditions:
- Type II diabetes
- High blood pressure
- Heart and lung disease
- Bleeding disorders
Will This Surgery Hurt?
For most people, local anesthesia blocks pain during surgery. There may be some burning or stinging with ALT and LPI. Some people report mild discomfort during these procedures.
Incisional glaucoma surgeries tend to have more discomfort after the procedure than laser procedures. Your doctor will discuss pain medications for recovery with you.
What Do I Need to Do Afterwards?
It’s very important to follow your doctor’s instructions. The recovery period is crucial to getting the best results.
After the procedure, your doctor will give you an eye exam. You may also get eye drops or an eye patch. You need to use these aids as instructed.
You will need to limit your eye’s exposure to water until you’ve recovered. This means avoiding activities like swimming. You should also ask about how to safely wash your face and bathe.
Follow your doctor’s recommendations on activities. It’s likely you’ll need to stop doing heavy lifting, straining, or driving until your doctor says it’s okay at a follow-up appointment.
When Do I Need to Call My Doctor?
Your doctor will schedule regular follow-ups to keep an eye on your recovery. You should call immediately if you notice any of the following symptoms:
- Sudden and/or severe eye pain
- Loss of vision or other eyesight changes
- Signs of infection, like fever and chills
- Nausea or vomiting
- Redness, swelling, increasing pain, excessive bleeding, or any eye discharge
- Pain that can't be controlled with medication
- Cough, shortness of breath, or chest pain
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