Major Glaucoma Surgery

Major glaucoma surgery is typically reserved for cases of dangerously high eye pressure, severe and refractory glaucoma, or when the eye’s natural drains are unsalvageable.

There are two types of major glaucoma surgery: trabeculectomy/Express shunt and glaucoma drainage implant. Essentially, both of these involve making a new “drain” for the eye, and the outcome is largely dependent on how a patient’s body responds to the surgery.

Even in the best of hands, these surgeries have a higher rate of complication compared to most other eye surgeries, and the decision to proceed with major glaucoma surgery should not be taken lightly.

Dr. Joseph will attempt to exhaust any and all options to avoid major glaucoma surgery, but if you end up needing the surgery, he will discuss the operation with you in detail, will skillfully perform the surgery, and will be with you every step of the way postoperatively.

  1. Trabeculectomy/Express shunt – During a trabeculectomy or Express shunt surgery, a small piece of the sclera (outer wall of the eye) is removed to create a small opening for fluid from inside the eye to drain better. Occasionally, a small metal device called the Express shunt is used to help regulate the flow through this opening. The conjunctiva is then meticulously closed with sutures to prevent any leakage of fluid (leaking fluid can lead to aggressive infections and/or dangerously low eye pressures). The end result of the surgery is the creation of a small reservoir called a bleb, which provides the eye a space to drain excess intraocular fluid. The postoperative course is variable, and patients are typically seen numerous times in the weeks following the operation.
  2. Glaucoma Drainage Implant – Glaucoma drainage implants are devices that consist of a tube that is inserted into the eye and a plate that is sutured to the outside part of the eye. Once the implant is placed, excess fluid in the eye is able to drain through the tube and to the outside of the eye, thus lowering eye pressure and improving glaucoma control. Like with trabeculectomies, the postoperative course is variable, and surgical success is highly dependent on the healing response of each individual patient.