Glaucoma Surgery

Drainage procedures from laser to tubes

Overview

Glaucoma surgery covers laser and incisional procedures that lower intraocular pressure by improving the outflow of aqueous humor or reducing its production. Laser trabeculoplasty, particularly selective laser trabeculoplasty, treats the trabecular meshwork drainage tissue and is used both as an initial treatment and alongside eye drops. Laser peripheral iridotomy creates a small opening in the iris to treat or prevent angle closure. Minimally invasive glaucoma surgery, MIGS, includes small stents and procedures on the drainage angle or Schlemm canal, such as the iStent, Hydrus, and goniotomy, often combined with cataract surgery, and is generally safer but less powerful than traditional surgery. Trabeculectomy, introduced in the 1960s, creates a guarded drainage channel under a flap of sclera into a filtering bleb beneath the conjunctiva and remains a standard incisional operation. Glaucoma drainage devices, such as the Ahmed and Baerveldt implants, route fluid through a tube to a plate on the outer wall of the eye. Cyclodestructive procedures reduce fluid production by treating the ciliary body and are often reserved for refractory disease.