{"id":91596459943,"date":"2025-11-18T07:09:02","date_gmt":"2025-11-18T06:09:02","guid":{"rendered":"https:\/\/www.augenarzt-banyai.de\/blog\/general\/when-eye-drops-and-slt-arent-enough-an-overview-of-glaucoma-surgery-and-migs\/"},"modified":"2026-06-22T09:47:09","modified_gmt":"2026-06-22T07:47:09","slug":"when-eye-drops-and-slt-arent-enough-an-overview-of-glaucoma-surgery-and-migs","status":"publish","type":"post","link":"https:\/\/www.augenarzt-banyai.de\/en\/blog\/glaucoma\/when-eye-drops-and-slt-arent-enough-an-overview-of-glaucoma-surgery-and-migs\/","title":{"rendered":"When eye drops and SLT aren\u2019t enough: an overview of glaucoma surgery and MIGS"},"content":{"rendered":"\n

Glaucoma<\/a> cannot always be managed with eye drops or selective laser trabeculoplasty (SLT) alone. In some cases, pressure control is insufficient \u2013 or damage to the optic nerve continues to progress despite treatment.\u00a0<\/p>\n\n\n\n

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).<\/p>\n\n\n\n

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Read more about glaucoma<\/a><\/div>\n<\/div>\n\n\n\n

When is glaucoma surgery advisable?<\/h2>\n\n\n\n

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.<\/p>\n\n\n\n

The aim of any operation is to improve the drainage of aqueous humour and thus permanently lower intraocular pressure<\/a> \u2013 in order to preserve the function of the optic nerve as effectively as possible.<\/p>\n\n\n\n

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Further information on glaucoma surgery<\/a><\/div>\n<\/div>\n\n\n\n

Proven glaucoma surgery at B\u00e1nyai Augenheilkunde<\/h2>\n\n\n\n

Depending on the type and severity of the glaucoma, different surgical procedures are used, each tailored to the individual patient\u2019s needs.<\/p>\n\n\n\n

Trabeculectomy: The gold standard<\/h3>\n\n\n\n

Trabeculectomy has been used successfully for decades to reduce intraocular pressure and is considered the standard procedure for advanced glaucoma. <\/p>\n\n\n\n

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 \u2013 often, eye drop treatment can be significantly reduced or even stopped altogether after the procedure. <\/p>\n\n\n\n

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.<\/p>\n\n\n\n

Canaloplasty: Gentle and effective<\/h3>\n\n\n\n

Canaloplasty is a minimally invasive procedure that utilises the natural drainage pathway for aqueous humour. <\/p>\n\n\n\n

A microcatheter is used to fully probe and dilate Schlemm\u2019s canal. In addition, a tension-maintaining suture implant may be inserted to keep the canal permanently open. <\/p>\n\n\n\n

Unlike trabeculectomy, canaloplasty does not create an artificial drainage pocket under the conjunctiva, resulting in a lower complication rate during the healing phase. <\/p>\n\n\n\n

The method is particularly well suited to patients with moderate intraocular pressure and intact anterior chamber angle anatomy. <\/p>\n\n\n

\"Auge<\/picture><\/figure><\/div>\n\n\n

Combination with cataract surgery<\/h3>\n\n\n\n

Many glaucoma patients also develop cataracts over time. In such cases, combined surgery can be a sensible option \u2013 both from a therapeutic and a practical perspective. <\/p>\n\n\n\n

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. <\/p>\n\n\n\n

Another advantage is that patients only need to undergo one anaesthetic and one recovery process. <\/p>\n\n\n\n

At B\u00e1nyai Augenheilkunde, we carefully assess in advance which combination is best suited to each individual \u2013 always with the aim of achieving the best balance between visual acuity, pressure control and quality of life.\u00a0<\/p>\n\n\n\n

A combined operation \u2013 that is, the removal of the clouded lens and a pressure-lowering procedure \u2013 can be a particularly effective treatment option in such cases.<\/p>\n\n\n\n

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More information on cataract surgery<\/a><\/div>\n<\/div>\n\n\n\n

MIGS: Modern technology with limitations<\/h2>\n\n\n\n

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 \u2013 particularly for patients with early-stage glaucoma or in combination with cataract surgery. <\/p>\n\n\n\n

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. <\/p>\n\n\n\n

MIGS stands for \u2018Minimally Invasive Glaucoma Surgery\u2019 \u2013 an umbrella term for various micro-invasive procedures associated with low risk and a short recovery time. <\/p>\n\n\n\n

They are particularly suitable for early to moderate stages of glaucoma and are usually performed in combination with cataract surgery.<\/p>\n\n\n\n

Examples of MIGS procedures:<\/h3>\n\n\n
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