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IU Optometry Clinics & Patient Care: Patient Education Angle on Glaucoma: Treatments |
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Surgical Procedures Some types of glaucoma (e.g., angle closure glaucoma) may indicate surgery as a first-line therapy. Other types (e.g., primary open angle glaucoma) might initially be treated with medication to control damage and then later with surgery.
Laser surgeries use a concentrated beam of light to open the flow of aqueous out of the eye and thus decrease intraocular pressure. The two most common glaucoma laser surgeries are (1) trabeculoplasty and (2) iridotomy. A trabeculoplasty is most often used for open angle glaucoma and uses a laser to place new holes in the drainage area of the eye to allow the aqueous to drain more freely. A iridotomy is used to treat angle-closure glaucoma. This laser procedure makes a small hole in the iris of the eye to allows the aqueous to flow more freely and tries to prevent the iris from plugging up the drainage system called the trabecular meshwork. Most laser surgeries are performed in the doctor's office with little discomfort during the procedure. Mild eye irritation is usually the only symptom after surgery. Most patients can resume normal activities within a day or two. Laser surgery may not be the answer to treat all glaucoma patients. When vision loss by glaucoma is rapid or medication and/or laser surgery fails to lower IOP sufficiently, conventional surgery may be the best option.
Sometimes the placement of a small tube or valve in the eye through a tiny incision in the sclera is needed to control pressure. The valve is a regulator of aqueous within the eye. When the intraocular pressure reaches a certain level, the valve opens, allowing the fluid to flow out and be reabsorbed into the bloodstream. The healing process for incisional surgery is usually only a few days. There are some instances where surgery alone does not completely work. Some patients may have to return to medication and some may need additional surgery to prevent any further loss of vision. What Is Glaucoma? | Types of Glaucoma | Diagnosing Glaucoma | Treatments | Research & Links | Glaucoma Home 
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A glaucoma surgeon must evaluate the patient and decide which type of surgery is best. Surgeries for glaucoma may be performed using laser or conventional surgical instruments. 
The most common conventional surgical procedure is called filtering surgery. Filtering surgery is usually done in a hospital or outpatient surgery center. A tiny piece of the white part of the eye (the sclera) is removed leaving a small hole. The aqueous can then drain through the hole and be reabsorbed into the bloodstream. This in turn decreases intraocular pressure.