What are the Different Types of Glaucoma Eye Surgery?

Mike Howells

Glaucoma is a painful disease in which fluid builds up in one or both eyes, increasing intra-ocular pressure and causing severe discomfort and, eventually, blindness if not treated. There are a number of treatments available for glaucoma sufferers, ranging from the mild to the complex. The most involved option recommended by doctors is surgery. Glaucoma eye surgery, of which there are two main types, attempts to increase fluid drainage within the eye, thereby reducing pressure, pain, and damage to the optic nerve.

Laser eye surgery can be used to treat glaucoma without a scalpel.
Laser eye surgery can be used to treat glaucoma without a scalpel.

The two types of glaucoma eye surgery are laser and incision, which involves a traditional scalpel. They are not always interchangeable procedures, and laser treatment is typically recommended before physical surgery. Both, however, are usually only suggested as options after drug therapies have been tried or dismissed for various reasons.

A scalpel is a small, sharp knife that is used for performing surgeries.
A scalpel is a small, sharp knife that is used for performing surgeries.

The laser treatment for glaucoma generally involves creating a number of very small scars in the eye's natural drainage system, which is called the trabecular meshwork. It is a virtually painless procedure and done on an out-patient basis. If successful, the scars increase the ability of the natural drainage system to evacuate fluid. Laser glaucoma eye surgery has the benefit of allowing for quick recovery, with a large proportion of patients even being able to drive the following day.

Traditional incision surgery for glaucoma is generally an outpatient procedure, but it can cause discomfort.
Traditional incision surgery for glaucoma is generally an outpatient procedure, but it can cause discomfort.

Traditional incision surgery for glaucoma typically involves making a small hole near the bottom of the front of the eye, leaving a small flap of tissue connected to help regulate discharge. This procedure is known as a trabeculectomy, and though it is also an outpatient procedure, it usually causes patients more discomfort and takes longer to recover from than the laser option.

A newer variation of the trabeculectomy is called a viscocanalostomy, which involves only perforating tissue at the bottom of the eye rather than punching a hole through it. This technique is considered less invasive and more of a middle ground between laser surgery and a full incision. Like the latter, though, it is also often done under general anethesia, which typically increases recovery time.

The success rate for either type of glaucoma eye surgery is good, usually ranging from 70% to 90%. In some cases, however, the hole or laser work may heal over and lead to increasing pressure again. Repeat surgeries are possible, and, for patients who have multiple recurrences, it may become necessary to install a physical stent to maintain a drainage hole. Interestingly, the failure rate is higher in younger people, as they are more likely to heal than the elderly.

Anatomy of a healthy human eye.
Anatomy of a healthy human eye.

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