11th Aug 2020
glaucoma surgery


What is Glaucoma?

Glaucoma is a chronic, progressive deterioration of the optic nerve fibers at the back of the eye that carry visual messages from the retina to the brain. Glaucoma is usually caused by or worsened by intraocular pressure inside the eye that is too high for the continued health of the nerve.

What is glaucoma treatment?

Glaucoma treatment can involve surgery, laser treatment or medication, depending on the severity. The damage done by glaucoma is permanent and seems impossible to retract but with medications and surgical procedure, the damage can be controlled. Here are the best known glaucoma treatments:


First line glaucoma treatment involves using eye drops with medication aimed at lowering intraocular pressure. The prescribed eye drops work by reducing the eye pressure by enhancing the fluid drains from your eyes or by reducing the fluid among your eye generated. Your eye pressure determines which of the flowing eye drops would be suitable:

Glaucoma medication types:

Prostaglandins – The very first type of eye drop used by most of the glaucoma patients to increase the outflow of the fluid in our eyes as a result of that, the eye pressure reduces. The group of prostaglandins consists of medicines including bimatoprost (Lumigan), travoprost (Travatan Z), Latanoprost (Xalatan), tafluprost (Zioptan) and latanoprostene bunod (Vyzulta). Prostaglandins are prescribed for once-a-day use.

Side effects include:

  • Mild reddening
  • Burning sensation
  • Iris darkening
  • Blurry vision
  • Eyelashes or eyelid skin’s pigment darkening

Alpha-adrenergic agonists

Alpha-adrenergic agonists or ADA medications are highly reliable eye drops known for reducing the intraocular pressure. They are responsible for reducing the production of the fluid (aqueous humour) our eye makes thereby decreasing the pressure. The three kinds of alpha-adrenergic agonists drugs are apraclonidine(iopidine), dipivefrin (Propine) and brimonidine (Alphagan, Alphagan P). ADA is prescribed for two times in a day but can also exceed three times a day depending on your eye condition.

Side effects include:

  • Fatigue
  • Red eyes
  • Itchy eyes
  • Swollen eyes
  • Dry mouth
  • Irregular heart rate

Beta-Blockers – These eye drops reduce the production of the fluid in our eye hence decreasing the intraocular pressure. Beta-blockers types include timolol (Betimol, Timoptic, Istalol) and betaxolol (betoptic). This medication is prescribed for once or twice usage in a day.

Side effects include:

  • Hard time breathing
  • Lower blood pressure
  • Slow heart rate
  • Fatigue
  • Impotence

Carbonic anhydrase inhibitors – CAI medications are reliable for reducing the production of fluid in our eyes. Carbonic anhydrase inhibitors styles include dorzolamide (Trusopt) and brinzolamide (Azopt). This medication is often prescribed for twice for each day of use, sometimes even thrice in a day.

Side effects include:

  • Frequent urination
  • Metallic taste
  • Tingling fingers & toes

Miotic or Cholinergic agents – Used to increase the outflow of fluid (aqueous humour) from the eyes. One of its kind is pilocarpine (Isopto Carpine). This medication is optimally prescribed for 4 times a day but due to its side effects, it’s rarely prescribed to people anymore.

Side effects include:

  • Headache
  • Smaller pupils
  • Blurry vision
  • Dim Vision
  • Eye pain
  • Nearsightedness

Rho-kinase inhibitor – This medication reduces the eye pressure through suppressing the rho kinase enzymes that are responsible for the fluid increase. It’s available as Netarsudil and asked to be used once in a day.

Side effects include:

  • Eye discomfort
  • Eye redness
  • Deposits around the eye
  • Glaucoma Surgery

The only proven glaucoma treatment is lowering eye pressure in order to prevent or to slow down the damage to the optic nerve. It’s commonly done through glaucoma surgery that includes delicate and microscopic equipment. There are also newer procedures for glaucoma treatment called minimally invasive glaucoma surgery that have a higher safety profile.

Each type of glaucoma surgery has its unique advantages and disadvantages. These surgeries have a very high success rate in slowing down the progression of glaucoma.

Minimally Invasive Glaucoma Surgery (MIGS)

It’s a safer and often suggested option for glaucoma surgery. Considering a minimally invasive glaucoma surgery (MIGS) before a standard glaucoma surgery like trabeculectomy, or Iridotomy with severe complication is a smart choice. MIGS help to effectively lower the eye pressure and prevent the growth of glaucoma or further damage in the eye, it tends to cause fewer side effects and complications.

MIGS surgical process involves the use of microscopic-sized equipment and tiny incision to increase the outflow of the fluid (aqueous humour) from the eye. The trabecular meshwork causes a halt in the normal outflow of aqueous fluid. The trabecular meshwork is an area of tissue, located at the base of the cornea that’s responsible for the drainage of aqueous humour from the eye. Once it gets clogged, the eye pressure increases to a concerning level
causing serious compilation in the eye.

MIGS procedures help to tackle the growing pressure by reducing the eye pressure through creating a new way through or around the trabecular meshwork. Tiny devices are used in the aqueous humour to drain from the eyes more effortlessly.

There are different types of MIGS procedures that include: 

  • Mircrotraveculectomy
  • Internal trabecular bypass procedures
  • Certain Laser procedures

Micro Trabeculectomy surgery involves extremely microscopic-sized tubes inserted in the drainage angle for the outflow of aqueous fluid from the anterior chamber of the eyes. New devices that contribute to trabeculectomy operation sager are Xen Gel Stent and PRESERFLO Microshunt.

Selective laser trabeculoplasty (SLT) for laser glaucoma surgery is one of the latest surgical treatments for open-angle glaucoma that might reduce the amount of eye drops a person needs to use every day for treating glaucoma. In this procedure, a laser is used to create tiny holes to allow eye fluid to drain easily and thereby lowering the eye pressure. Laser glaucoma surgery holds a 10% success rate among patients and lowers the eye pressure to 20 to 30 per cent.


It is one of the most standard glaucoma surgeries than the rest of the procedure, used for a significant decrease in intraocular pressure that helps to control glaucoma. In Trabeculectomy, a part of the trabecular meshwork is removed to help with an outflow of aqueous fluid.

At the exterior junction of cornea and sclera, there’s an incision made and folded back a portion of the conjunctiva that covers the sclera and creates a flap in the sclera. The scalp flap is put back and stitched with tiny nylon sutures in the palace to create an adjustable drainage valve.

Trabeculectomy takes place on the upper area of the eye (under the eyelid), so this bled and incisions made are not visible or seen by others.

Iridotomy and iridectomy

In the rarest kind of glaucoma known as narrow-angle glaucoma, a laser is used to create a small in the peripheral aris to regulate the outflow of aqueous humour through it. This procedure is called an iridotomy or peripheral laser iridotomy. While iridectomy involves removing a piece of the iris to create a bigger drainage hole.
This surgical procedure helps to reduce the risk of narrow-angle glaucoma turning into acute angle-closure glaucoma which is an extremely severe condition that causes IOP to increase rapidly. Acute angle-closure is extremely difficult to handle and needs immediate medical attention to prevent vision loss.

Glaucoma Treatment Complication

The benefits typically outweigh the rare risks associated with this surgery.

Vision Loss – Glaucoma surgery may temporarily disrupt your vision soon after the operation.

Bleeding – Uncommon or rare complications include bleeding inside the eye, infection, and fluid pockets behind the retina due to very low eye pressures and should be treated urgently.

Infection – On very rare occasions, despite antibiotics, infection inside the eye may occur, which can be very serious and may threaten vision for weeks, months, or even years after the surgery.

Low Eye Pressure – Sometimes, the surgery can lead to temporary eye pressures that are too low, also called hypotony. This is more common soon after the surgery causing a shadow in your peripheral or side vision.

Scarring – Some surgeries may fail over time due to the natural scarring tendencies of the eye, resulting in higher eye pressures.

Cataract – Cataract formation most likely will be accelerated by glaucoma surgery, but luckily cataracts are fairly easy to fix surgically.

It is also important to recognize that the vast majority of glaucoma surgeries are a successful glaucoma treatment slowing its progression and achieving the intended eye pressure. Post-surgery care for a glaucoma patient is essential as it may take a while before the patient can resume the activities of daily living. Emoha Elder Care provides 24-hour assistance and care by skilled home nurses to help with post operation recovery. With a customised care plan for each individual, healing in one’s home comfort has been made easy by Emoha.

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