Glaucoma Surgery

Minimally Invasive Glaucoma Surgery or MIGS

If first line treatment for glaucoma (eye drops or laser) is unsuccessful in stabilising a patient’s glaucoma, or have proven unsuitable due to side effects, then surgery may be required.

Recently, new surgical treatments have been introduced called Minimally Invasive Glaucoma Surgery or MIGS. These surgeries, in comparison to traditional surgical techniques, have a lower complication rate and are often performed at the same time as cataract surgery. They can also be performed as a standalone procedure, and still allow for subsequent, traditional glaucoma drainage surgery if required.

There are a number of different MIGS procedures, but most commonly in Australia, this procedure involves the insertion of micro stents into the drainage angle of the eye, improving the drainage of fluid out of the eye.

These procedures have been shown to reduce eye pressure and are very safe. 

Trabeculectomy or Tube Shunt

These operations are performed at day surgery under local or general anaesthetic.

Trabeculectomy: An alternative drainage pathway for fluid within the eye is created by making a small opening in the wall of the eyeball (sclera) and into the front chamber of the eye. Fluid then drains from within the eye, out through the hole, and into the vessels of the membrane covering the eye (conjunctiva). The flow of fluid into the space underneath the conjunctiva causes a raised blister or ‘bleb’ that helps control the flow of fluid out of the eye – allowing a lowering of pressure without it becoming too low. The drainage bleb typically sits, hidden, underneath the upper eyelid.

This procedure typically takes 1 to 2 hours to perform, under local or general anaesthesia, and has been used to treat advanced Glaucoma for over 40 years. Although the complication rates are relatively higher than MIGS surgeries, the pressure lowering effect is typically greater, and lasts longer.

Tube Shunt: This procedure is similar to a trabeculectomy in that in creates an alternative fluid drainage pathway out of the eye, lowering eye pressure. It differs, however, in that a small drainage tube is inserted into the front chamber of the eye and attaches to a plate that sits underneath the white of the eye.

The tube creates a passage for fluid to from within the eye, into a bleb that forms over the attached drainage plate. Often the tube is partially obstructed by the surgeon, using a stent or an external tying suture, to prevent the eye pressure becoming too low.

Tube shunt glaucoma drainage surgery is an option in advanced glaucoma, or where other treatments and surgeries have failed. It usually takes 1 to 2 hours to perform the procedure, under general or local anaesthesia.