Glaucoma cannot always be managed with eye drops or selective laser trabeculoplasty (SLT) alone. In some cases, pressure control is insufficient – or damage to the optic nerve continues to progress despite treatment.
In such cases, surgical intervention may be necessary to slow the progression of the disease. In this article, we provide a comprehensive overview of common glaucoma surgeries and explain modern micro-invasive procedures (MIGS).
Surgery is considered when the target pressure cannot be achieved with eye drops or SLT, when side effects significantly impair quality of life, or when the optic nerve continues to deteriorate despite stable readings.
The aim of any operation is to improve the drainage of aqueous humour and thus permanently lower intraocular pressure – in order to preserve the function of the optic nerve as effectively as possible.
Depending on the type and severity of the glaucoma, different surgical procedures are used, each tailored to the individual patient’s needs.
Trabeculectomy has been used successfully for decades to reduce intraocular pressure and is considered the standard procedure for advanced glaucoma.
A so-called drainage pouch is placed under the conjunctiva, allowing aqueous humour to drain away permanently. The effect is usually significant and long-lasting – often, eye drop treatment can be significantly reduced or even stopped altogether after the procedure.
However, the procedure requires an experienced surgeon and close post-operative monitoring, as fluctuations in pressure, wound-healing reactions or temporary deterioration in vision may occur during the recovery phase.
Canaloplasty is a minimally invasive procedure that utilises the natural drainage pathway for aqueous humour.
A microcatheter is used to fully probe and dilate Schlemm’s canal. In addition, a tension-maintaining suture implant may be inserted to keep the canal permanently open.
Unlike trabeculectomy, canaloplasty does not create an artificial drainage pocket under the conjunctiva, resulting in a lower complication rate during the healing phase.
The method is particularly well suited to patients with moderate intraocular pressure and intact anterior chamber angle anatomy.
Many glaucoma patients also develop cataracts over time. In such cases, combined surgery can be a sensible option – both from a therapeutic and a practical perspective.
Cataract surgery alone can already bring about a moderate reduction in intraocular pressure. If a pressure-lowering procedure, such as canaloplasty or trabeculectomy, is carried out at the same time, the effects can be combined.
Another advantage is that patients only need to undergo one anaesthetic and one recovery process.
At Bányai Augenheilkunde, we carefully assess in advance which combination is best suited to each individual – always with the aim of achieving the best balance between visual acuity, pressure control and quality of life.
A combined operation – that is, the removal of the clouded lens and a pressure-lowering procedure – can be a particularly effective treatment option in such cases.
Minimally invasive procedures such as MIGS have attracted a great deal of attention in recent years. They promise a gentle treatment, low complication rates and short recovery times – particularly for patients with early-stage glaucoma or in combination with cataract surgery.
Nevertheless, their effectiveness is limited when a greater reduction in intraocular pressure is required. Particularly in cases of advanced glaucoma, MIGS methods are often insufficient to reliably relieve pressure on the optic nerve.
MIGS stands for ‘Minimally Invasive Glaucoma Surgery’ – an umbrella term for various micro-invasive procedures associated with low risk and a short recovery time.
They are particularly suitable for early to moderate stages of glaucoma and are usually performed in combination with cataract surgery.
At Bányai Augenheilkunde, we are following the development of micro-invasive procedures with great interest. Nevertheless, we have made a conscious decision not to offer MIGS as part of our range of services at this stage.
Our focus is on procedures with clearly proven long-term efficacy – particularly for patients with moderate to advanced glaucoma.
In daily practice, it is repeatedly evident that thorough surgical planning, close follow-up care and individually tailored surgical methods deliver more reliable results than standardised implants with limited pressure reduction.
A detailed consultation is crucial to finding the most suitable form of treatment together.
This takes into account not only medical criteria, but also your personal circumstances, wishes and expectations regarding the procedure.
For some patients, the main goal is a future with as few eye drops as possible; others prioritise minimal post-operative discomfort or the shortest possible disruption to their daily lives.
During your consultation at Bányai Augenheilkunde, we therefore assess on an individual basis which procedure best suits not only your clinical presentation but also your everyday reality. This leads to a decision that is both medically sound and practical for your daily life.
The choice of the appropriate procedure depends largely on the individual stage of glaucoma, the patient’s age, any existing comorbidities, the condition of the anterior chamber angle, and any previous treatment with eye drops or SLT.
A detailed consultation is crucial to finding the right form of treatment together.
When conservative measures are no longer sufficient, surgical glaucoma treatment offers new ways to protect the optic nerve.
At Bányai Augenheilkunde, we focus on each patient’s individual situation – with the aim of effectively halting the progression of glaucoma.
MIGS procedures are an important topic in ophthalmology, but they are not the optimal solution for everyone. We provide you with honest, transparent and well-informed advice.
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