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by Dr Maria Hannah Pia de Guzman

Various types of surgery can be used to lower intraocular pressure. Since surgery is riskier than medical or laser treatment it is often only done when other types of treatment are inadequate, not applicable, or not expected to work. The exception to this is infantile glaucoma (a.k.a. congenital glaucoma) for which surgery is the primary treatment although medications can be used temporarily while preparing for surgery.

Trabeculectomy is the most commonly performed glaucoma surgery. It can be used for both open-angle and angle-closure glaucoma. It involves the creation of an alternative fluid drainage pathway out of the eye’s own tissue. The new pathway goes from the anterior chamber to a pocket under the transparent lining (conjunctiva) of the white part of the eye (sclera). The most common complications of this procedure are too little or too much fluid drainage and cataract formation or progression. The effectiveness of the procedure usually lasts for several years but eventually starts to decrease due to the body’s natural attempt to heal (close) the unnatural pathway.

There are many different kinds of implants that can be used with or instead of a trabeculectomy. These implants are called glaucoma drainage devices. They are usually used in cases where a trabeculectomy is not expected to succeed. There are also implants that can be inserted using minimally invasive techniques although they tend to be less effective than trabeculectomy (higher intraocular pressures achieved).

Even with successful surgery glaucoma still cannot be cured and patients need to be monitored continuously for intraocular pressure control and progression of the glaucoma.