Glaucoma Surgery

Glaucoma is an eye disease that can be treated by both surgical and non-surgical methods. When non-surgical options have been exhausted a number of surgical options are available. 

We provide a very personalised service with the goal of preventing loss of vision, as vision loss from glaucoma is irreversible. 

Anatomy diagram of glaucoma

What is glaucoma and what are the symptoms?

Glaucoma is a disease that causes damage to your optic nerve and progressively becomes worse over time. In most cases, the damage is caused through an increased pressure inside the eye. To find out more about symptoms and diagnosis, please visit our overview of the glaucoma eye condition.

Is there a cure for glaucoma?

Unfortunately, there is no cure for glaucoma. But there are a number of treatment options available to help reduce eye pressure and minimise or prevent further vision loss. Sometimes a combination of treatments may be used. Patients with glaucoma need ongoing care by an Ophthalmologist.

What non surgical treatments are there for glaucoma?

Long-term use of eye drops is very effective in controlling eye pressure for most people with glaucoma. However, these medications can sometimes stop being effective or may cause side-effects, such as stinging or irritation. It’s important that you don’t stop eye drop treatment without consulting your ophthalmologist first, as this may lead to further loss of vision.

Types of GLAUCOMA surgery

Glaucoma Laser Surgery

Laser surgery has become increasingly popular as an intermediate step between drugs and traditional surgery though the long-term success rates are variable. Types of laser treatment for glaucoma include:

Trabeculoplasty

This is the most common procedure for open-angle Glaucoma. It takes between 10-15 minutes, is painless and can be performed in a doctor’s office. The laser changes the structure of the eye’s drain allowing the aqueous fluid to pass out more easily. This can delay or avoid further glaucoma surgery altogether.

Selective Laser Trabeculoplasty (SLT)

A newer laser treatment for open-angle glaucoma that uses very low levels of energy. For this reason, it is believed that SLT, unlike other types of laser surgery, may be safely repeated.

Laser Peripheral Iridotomy (LPI)

The preferred method for managing a wide variety of angle-closure glaucomas. This laser is most often used to treat an anatomically narrow angle and prevent angle-closure glaucoma attacks. An opening is made through the iris, allowing aqueous fluid to flow from behind the iris directly to the anterior chamber of the eye. This allows the fluid to bypass its normal route.

Cycloablation

Cycloablation reduces the amount of aqueous humour in the eye by destroying part of the ciliary body, which produces the fluid. This treatments is usually reserved for use in eyes that either have elevated IOP after having failed other more traditional treatments.

What to expect with glaucoma laser surgery

  • Your doctor will check your IOP one hour following laser surgery. You may go home and resume your normal activities following surgery.
  • It may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medications, many patients are eventually able to discontinue some of their medications.
  • After this procedure, many patients respond well enough to be able to avoid or at least delay surgery.
  • Your eye doctor is the best judge of determining whether or not you will still need glaucoma medication. It is important to follow post operative instructions even if the symptoms appear to have subsided.
  • Complications with laser are minimal, which is why this procedure has become increasingly popular and some centres are recommending the use of laser before drops in some patients.

Trabeculectomy Surgery

This is the most common type of glaucoma surgery. This is used in both open-angle and closed-angle glaucoma. About 50 per cent of patients no longer require glaucoma medications after surgery for a significant length of time. 

What to expect during your trabeculectomy surgery

  • A trabeculectomy usually only involves day surgery.
  • The surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A flap is created that allows fluid to escape, but which does not deflate the eyeball.
  • A small bubble of fluid called a "bleb" forms over the opening on the surface of the eye, which is a sign that fluid is draining out into the space between the sclera and conjunctiva. Occasionally, the surgically created drainage hole begins to close and the IOP rises again. This happens because the body tries to heal the new opening, as if it was an injury.
  • The number of post-operative visits to the doctor varies, and some activities, such as driving, reading, bending and heavy lifting must be limited for two to four weeks after surgery.

Drainage Implant Surgery

A small silicone tube is connected to one or more plates, which are sutured to the surface of the eye, usually not visible. Fluid is collected on the plate and then absorbed by the tissues in the eye. This type of surgery is thought to lower IOP less than trabeculectomy but is preferred in patients whose IOP cannot be controlled with trabeculectomy or who have previous scarring

Non-penetrating Surgery

Newer, non-penetrating glaucoma surgery, which does not enter the anterior chamber of the eye, shows great promise in minimising postoperative complications and lowering the risk for infection. However, such surgery generally does not currently lower IOP as much as trabeculectomy. Furthermore, long term studies are needed to assess these procedures and to determine their appropriate role treating glaucoma patients.

I-Stent combined with cataract surgery

In the past, glaucoma and cataract surgery were two separate procedures. The iStent has been available in Australia since 2014 and consists of two very small, titanium stents that are surgically implanted into the tissue that drains fluid away from the eye. This is the first device that has been approved in conjunction with cataract surgery in patients with mild or moderate open-angle glaucoma and a cataract who are currently on IOP medication.

  • Protects eye tissue that often gets damaged by traditional surgeries.
  • Can be safely implanted during cataract surgery.
  • Has a rapid recovery time.
  • Allows for future treatment options for preserving vision.
For a diagnosis and to discuss treatment options of any eye condition, please make an appointment.