One of the strengths of our practice is the broad array of glaucoma surgeries we offer our patients. We are proud to be the only practice in Arizona that can offer such a broad array of surgeries to our patients. We cater our surgical choices to each patient’s particular situation to ensure the best outcome possible.
All glaucoma surgeries aim to reduce the eye pressure to improve the environment for the optic nerve. They can be classified into procedures that decrease fluid production (Inflow) with the eye and procedures that increase fluid drainage (Outflow) from the eye.
The procedures listed below are some of the most commonly performed in our practice. The list is not comprehensive, nor does it cover experimental surgeries being performed at our practice through clinical research trials. If you have any questions about a procedure you may have heard about but do not see listed here, please feel free to contact us for additional information.
These are the conventional surgeries that have been used for decades to significantly lower eye pressure in patients whose vision and quality of life are threatened by glaucoma.
“The gold standard”
This procedure is the most tested procedure and still the most commonly performed glaucoma surgery. A small opening is made in the wall of the eye to create a communication from inside the eye to the surface of the eye, and fluid tracking through this connection pools into a dome hidden underneath the upper eyelid. This dome of fluid is called a bleb. In this way, fluid is removed from the eye and the intraocular pressure becomes decreased.
Aqueous Shunt Surgery
“Drainage Implant Device”
Like trabeculectomy, this surgery creates a communication from inside the eye to a reservoir of fluid on the surface of the eye. However, a device with a small silicone tube is used to create the communication. This procedure is usually performed in patients who have failed other glaucoma surgeries, or patients who have specific types of glaucoma such as neovascular angle-closure glaucoma.
Watch a video on Aqueous Shunt Surgery
“strategic laser targeting of the eye’s faucet”
A laser is used to shrink the fluid-producing glands within the eye to reduce eye pressure. The most common version is a probe placed on the surface of the eye. It is quick procedure done without cutting into the eye and is usually performed in patients with advanced glaucoma or those who have undergone multiple eye surgeries. There are also more gentle forms of the procedure available including one version that uses a camera endoscope (ECP) to directly visualize and target the glands responsible for producing eye fluid.
Watch a video on Cyclophotocoagulation
Microinvasive glaucoma surgeries – a safer way to lower eye pressure when maximal effect is not needed.
Trabecular Bypass Devices
Metallic microstents help fluid in the eye bypass the trabecular meshwork- the “point of greatest resistance” to fluid exiting the eye- and enter the canal of Schlemm to lower the eye pressure.
They are permanent and not able to be felt by the patient. They are often used at the time of cataract surgery. There are different types of stents available.
Kahook Duo Blade
“selective meshwork removal”
Watch a video on the Kahook Duo Blade
“navigate and dilate the eye’s microcanal”
The goal of this surgery is to optimize and enhance the eye’s natural drainage pathways rather than create a new pathway for fluid to flow inside the eye to the eye surface. This procedure uses a fiber-optic probe to pass through a canal whose width is approximately 1/100th of a centimeter. The probe extrudes a clear gel substance that is believed to dilate and break adhesions within the canal. This procedure can be done from within the eye or from outside of the eye, and it is often done at the time of cataract surgery.
“a gentle alternative to trabeculectomy”
This procedure uses a tiny microstent to shunt fluid from inside the eye to the outer surface of the eye. In some ways, it is a hybrid of the conventional glaucoma surgeries because it creates a reservoir of fluid (bleb) on the eye surface via a small polymer microshunt, but it theoretically carries less risk than either conventional procedure.
Watch a video on the XEN microstent
Non-surgical Laser Procedures
These procedures are routinely done in patients with glaucoma or patients at risk for specific types of glaucoma.
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) opens the trabecular meshwork by targeting specific pigment cells of the eye. In produces a change in the trabecular meshwork without producing clinically observable scarring or other harm to the tissue. This procedure is particularly effective in patients with early to mild glaucoma who are not already using glaucoma eye drop medications.
Watch a video on Trabeculoplasty
Laser iridotomy (LPI)
This procedure is typically completed in the office. A laser is used to create a small opening at the outer edge of the iris. This allows the fluid to move more freely between the chambers of the eye and prevents a sudden buildup in pressure.