Glaucoma surgery aims to lower the pressure inside the eye. Several techniques are available: stent placement in the iridocorneal angle, filtering surgery (trabeculectomy, non-penetrating sclerectomy, microshunt…), or cataract surgery (in angle-closure).
Before surgery: SLT laser
Before considering surgery, an SLT laser (selective trabeculoplasty) may be offered: performed at the practice, painless and quick, it stimulates the eye's natural filter (the trabecular meshwork) to improve aqueous outflow and lower the pressure. It can delay, or even avoid, surgery.
The pre-operative work-up
The surgical decision is based on a full work-up: visual field, optic nerve OCT, intraocular pressure measurement and gonioscopy (examination of the iridocorneal angle). It is the progression of the glaucoma despite treatment that establishes the indication.
The procedure
These procedures are performed in most cases as day surgery under local anaesthesia. The principle of filtering surgery is to create an additional drainage pathway for the aqueous humour, which drains under the conjunctiva (filtering bleb). Stents and minimally invasive MIGS techniques are placed through a micro-incision, often during combined cataract surgery.
Post-operative course
The post-operative course depends on the type of surgery. Anti-inflammatory eye drops are prescribed and the intraocular pressure is closely monitored during the first weeks, with possible adjustments during follow-up. Avoid rubbing the eye and strenuous effort at first. After filtering surgery, pressure-lowering drops are stopped; after MIGS, treatment is rather reduced, depending on the pressure achieved.
Frequently asked questions
When should glaucoma be operated on?
Surgery is indicated when glaucoma progresses on visual field testing despite medical treatment (pressure-lowering drops, SLT laser).
Which technique is used for glaucoma surgery?
It depends on the type of glaucoma (open or closed angle) and on whether a cataract is present. In open-angle glaucoma, filtering surgery such as trabeculectomy or sclerectomy may be indicated. In angle-closure glaucoma, filtering surgery or cataract surgery, possibly combined with MIGS (Minimally Invasive Glaucoma Surgery) such as the iStent, may be indicated.
Is glaucoma surgery an emergency?
It depends on how quickly the glaucoma is progressing and on optic nerve damage, assessed by visual field testing.
Will I recover the vision I have lost?
No: established optic nerve damage is not reversible. The aim of surgery is to stop or slow progression — hence the importance of operating before the damage is too advanced.
Will I be able to stop my eye drops after surgery?
After filtering surgery, pressure-lowering drops are stopped. After MIGS, treatment is rather reduced, depending on the pressure achieved. In all cases, lifelong regular follow-up remains essential: glaucoma is a chronic disease, and pressure can rise again over time.
Does surgery cure glaucoma?
It does not erase the disease: it controls the intraocular pressure, the main factor we can act on. Monitoring of the visual field and optic nerve continues after surgery.
To go further: glaucoma (the condition), screening, open-angle glaucoma, acute glaucoma — and the fees and reimbursement page.
Information sheets from the French Society of Ophthalmology
To read before your procedure — information and consent sheet (in French):
📄 Chronic glaucoma surgery: filtering surgery (SFO sheet No. 3)PDF 📄 SLT laser treatment for glaucoma (SFO sheet No. 4)PDF 📄 Laser iris surgery: iridotomy (SFO sheet No. 6)PDFBook an appointment
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