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Surgery is not always necessary to treat glaucoma. Medicines can often control the pressure in the eyes, preventing further vision loss and blindness. Medicine will usually be tried first before surgery is considered.
Doctors can use either a surgical cutting tool or a very focused beam of light, called a laser, to perform surgery for glaucoma. Laser surgery is usually tried first when glaucoma medicines do not lower the pressure in the eyes (intraocular pressure, or IOP). If laser surgery does not help, your doctor may try conventional surgery.
Surgery may be needed for:
The primary goal of surgery for glaucoma is to preserve eyesight by:
In some cases surgery may be done to relieve pain caused by glaucoma.
There are three basic types of surgery for glaucoma in adults.
Surgery to increase drainage of fluid from the eye
This type of surgery involves making a trapdoor that allows fluid to drain from the eye. The surgeon can use either a laser or a surgical cutting tool to do this. In severe glaucoma, surgery also may involve putting in a filtering device (seton), usually made of plastic, that drains fluid away from the front part of the eye to a place where it can drain out of the eye. These procedures are used to treat open-angle glaucoma and long-term (chronic) closed-angle glaucoma.
Surgery to prevent closure of the drainage angle
Both laser and conventional surgeries can be used to prevent closure of the drainage angle. These procedures involve making a new opening in the colored part of the eye (iris) that allows fluid to flow through the eye. They are used to treat sudden (acute) closed-angle glaucoma and will prevent closed-angle glaucoma in people who have narrow drainage angles. Laser iridotomy can usually be done instead of surgical iridectomy. But some people with complicated or severe glaucoma may need to have surgical iridotomy.
Surgery to decrease the amount of fluid produced in the eye
When other surgery fails to improve the flow of fluid from the eye, procedures to destroy the part of the eye that produces fluid (ciliary body) can be done. These procedures are also used when scar tissue has formed after a previous surgery.
Destroying the ciliary body decreases the amount of fluid produced in the eye, reducing the pressure in the eye. Procedures that decrease fluid in the eye are only used for people with severe glaucoma that has not gotten better after they have tried medicines or other forms of surgery.
Surgery for congenital glaucoma
For congenital glaucoma, there are two slightly different procedures that both attempt to open the drainage angle directly. They are equally successful in children, but they are not used for adults. If these procedures fail in a child, then trabeculectomy or tube-shunt (seton glaucoma) surgery may be tried.
What to Think About
Clouding of the lens (cataract) can develop after surgery for glaucoma and is one reason that surgery is not usually used first to treat open-angle glaucoma.
Cataracts may occur in people who also have glaucoma. This commonly occurs in older people. Surgery to remove the cataract may be done at the same time as surgery for glaucoma. If surgery for glaucoma and a cataract are done at the same time, you may notice improved eyesight after surgery.
The decision whether or not to have surgery is often more difficult in glaucoma than in many other conditions because:
As with any other surgery, you and your doctor should make the decision to operate based on the risks and benefits of having the surgery. One factor to consider is which eye should be operated on first. There are other questions about glaucoma surgery that you should discuss with your doctor before making a decision.
Procedures to destroy the structures in the eye that produce fluid (cyclodestructive procedures) are usually used when other treatments, including other surgeries for glaucoma, have failed.4 Several treatments over time can destroy too much of the ciliary body, causing too little fluid to be produced. This can cause the eyeball to soften and lead to clouding of the lens (cataract).
eMedicineHealth Medical Reference from Healthwise
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