When medications and laser treatments are insufficient to control intraocular pressure, surgical intervention may be necessary. Modern glaucoma surgery offers a range of options from minimally invasive procedures to traditional filtration surgery.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS represents a paradigm shift in glaucoma surgery, offering safer alternatives with faster recovery. These procedures include trabecular micro-bypass stents (iStent), Schlemm's canal procedures (canaloplasty, OMNI), and subconjunctival drainage devices (Xen gel stent). MIGS are especially suitable for mild to moderate glaucoma and can often be combined with cataract surgery. Prof. Leshno has extensive experience with the full range of MIGS procedures.
Trabeculectomy
Trabeculectomy remains the gold standard of glaucoma filtration surgery for significant IOP reduction. A small flap is created in the sclera to allow controlled outflow of fluid from the eye into a filtering bleb under the conjunctiva. With proper management including antimetabolites (Mitomycin C), trabeculectomy can achieve excellent long-term pressure control. Prof. Leshno trained in advanced trabeculectomy techniques at Columbia University.
Glaucoma Drainage Devices
Tube shunt surgeries (Ahmed valve, Baerveldt implant) involve placing a small tube in the eye connected to a plate on the external surface of the eye. Fluid drains through the tube to the plate, where it is absorbed by surrounding tissues. These devices are particularly effective for complex or refractory cases, neovascular glaucoma, and eyes with previous failed filtration surgery.
Recovery and Follow-Up
Glaucoma surgery recovery time varies by procedure type. MIGS procedures typically allow return to normal activities within days. Trabeculectomy and tube shunt surgeries require more careful postoperative management over several weeks, including frequent follow-up visits and medications. Activity restrictions during recovery may include avoiding heavy lifting and strenuous exercise. Prof. Leshno will guide you through every step of your recovery.