Surgery for Glaucoma

A trabeculectomy, also known as glaucoma filtration surgery, is the most common glaucoma surgery. The aim of this procedure is to create another route through which the fluid can flow out of the eye, reducing pressure on the optic nerve. 

During a trabeculectomy, you are given a sedative so that you are relaxed. Your eye surgeon numbs your eye with drops as well. He or she removes a piece of tissue from the drainage angle of the eye to create a new opening. The opening is then partially covered with a flap of tissue from the white part of the eye, called the sclera. 

As the fluid flows through the new drainage opening, it causes the tissue to bubble up, in what is known as a bleb. This filtration bleb, which can last for a lifetime, serves as a guide for your doctor in the future to assess how well the fluid is flowing out of your eye. 

Studies show that this procedure is extremely effective for most people for at least one year. Potential complications include infection, swelling, low eye pressure, cataracts, and bleeding. After a year, the hole may begin to close. If needed, a trabeculectomy can be repeated multiple times in the same eye.

Currently, trabecular microbypass stenting, a form of microinvasive glaucoma surgery, is performed at NYU Langone. In this procedure, a tiny stent, or tube, is placed in the eye’s natural drainage system, improving the flow of fluid and reducing pressure in the eye. People who have this surgery may need fewer medications to manage their glaucoma. 

Trabecular microbypass stenting is typically combined with cataract surgery, a relatively common outpatient procedure to remove the cloudy lens of the eye. This combined approach allows surgeons to make one small incision to treat two conditions. Microinvasive glaucoma surgery does not change the recovery, safety, or complication rate of standard cataract surgery.

Tube implantation is a procedure in which a very small plastic tube is put into the eye to help filter fluid out of the eye. 

During this surgery, you are given a sedative so that you are relaxed, and your surgeon numbs your eye with drops as well. The main device involved in this procedure is a small tube that is connected to a round, flat plate. 

Your surgeon positions the plate in the back of the eye underneath the upper eyelid and against the eye itself. He or she then takes the small tube that is connected to it and carefully inserts it into the front chamber of your eye, usually just in front of the iris (the colored part of your eye).

The goal is for the eye fluid to drain through the tube into an area in the back of the eye near the implant, where it is collected and reabsorbed into the bloodstream. 

This procedure is highly effective in lowering eye pressure, and the results tend to be stable over time. Occasionally, the surgery can result in blurred vision, bleeding, discomfort, and low eye pressure. For this reason, the procedure is not offered unless the eye is at risk of severe vision loss from glaucoma.

After glaucoma surgery, your eye is usually taped shut, and a hard shield is placed over it. You wear a dressing over the eye the first night after surgery and the eye shield at bedtime for the next four weeks to allow for proper healing. 

For a week after surgery, you are advised to keep water out of the eye and to avoid any activities that strain it, such as reading, bending, or lifting heavy things. If your eye feels irritated or sore after the procedure, your doctor can prescribe medication to make you feel more comfortable.

For several weeks, your doctor may want you to put drops in the eye to prevent infection and inflammation. These drops are different from those you may have been using before surgery. Your doctor may request a follow-up within days after surgery to check on eye pressure and to look for any signs of infection or inflammation.

If you wear contacts or glasses, you may be advised to get new ones, because any surgery that lowers the eye pressure can affect the shape of the eye and, along with it, the prescription.