Laser and Surgical Treatment for Glaucoma
Glaucoma is a progressive eye disease in which elevated intraocular pressure damages the optic nerve, leading to irreversible vision loss if left untreated. While prescription eye drops are typically the first line of treatment, they are not always sufficient — some patients cannot tolerate the side effects, have difficulty with daily drop schedules, or continue to experience elevated pressure despite maximum medical therapy. In these cases, laser procedures or surgery may be recommended to lower intraocular pressure and protect remaining vision.
At West Boca Eye Center, Dr. Brent Bellotte offers a range of laser and surgical glaucoma treatments tailored to the type and severity of each patient's condition. The goal of every procedure is the same: reduce intraocular pressure to a level that prevents further optic nerve damage.
When Is Glaucoma Surgery Recommended?
Laser or surgical intervention is typically considered when:
- Eye drop medications are not adequately controlling intraocular pressure
- Side effects from glaucoma medications are intolerable (fatigue, respiratory issues, eye irritation, depression)
- The patient cannot reliably administer or afford daily eye drops
- Glaucoma is progressing despite maximum tolerated medical therapy
- The patient has acute angle-closure glaucoma requiring urgent intervention
- The patient prefers a reduced medication burden (dropless therapy approach)
For many patients, laser treatment or surgery can significantly reduce — or in some cases eliminate — the need for daily glaucoma eye drops.
Laser Procedures for Glaucoma
Selective Laser Trabeculoplasty (SLT)
SLT is the most commonly performed laser procedure for open-angle glaucoma. Using short pulses of low-energy laser light, the procedure targets pigmented cells in the trabecular meshwork — the eye's natural drainage system — to improve aqueous humor outflow without damaging surrounding tissue. SLT is performed in the office in under 10 minutes, requires no incision, and can be repeated if the effect diminishes over time. Many patients experience a meaningful reduction in intraocular pressure within one to three months after treatment.
For detailed information about this procedure, visit our Selective Laser Trabeculoplasty (SLT) page.
Laser Peripheral Iridotomy (LPI)
Laser iridotomy is the primary treatment for angle-closure glaucoma — a form of glaucoma in which the iris physically blocks the drainage angle of the eye. The procedure uses a focused laser to create a small opening in the outer edge of the iris, allowing aqueous humor to flow from behind the iris to the drainage angle. This equalizes pressure on both sides of the iris and opens the drainage pathway. LPI is performed in the office, takes only a few minutes, and is typically painless. It is also used preventively in eyes with narrow angles that are at risk of acute angle closure.
Cyclophotocoagulation
Cyclophotocoagulation uses laser energy to reduce the production of aqueous humor by targeting the ciliary body — the structure responsible for producing the fluid that fills the eye. This procedure is typically reserved for advanced or refractory glaucoma that has not responded to other treatments. It can be performed externally (transscleral cyclophotocoagulation) or internally (endoscopic cyclophotocoagulation, or ECP). Transscleral cyclophotocoagulation is often used for patients with limited visual potential or those who are not candidates for incisional surgery.
Surgical Procedures for Glaucoma
Trabeculectomy (Filtering Surgery)
Trabeculectomy is one of the most established surgical procedures for glaucoma. The surgeon removes a small section of the sclera (the white outer wall of the eye) and underlying trabecular meshwork to create a new drainage channel. Aqueous humor flows through this opening into a small reservoir (bleb) beneath the conjunctiva, where it is absorbed by surrounding tissues. Trabeculectomy is performed in an outpatient surgical setting under local anesthesia and is effective at significantly lowering intraocular pressure. Anti-scarring agents such as mitomycin C may be applied during surgery to prevent the drainage channel from closing.
Glaucoma Drainage Implant (Tube Shunt)
When trabeculectomy is not suitable or has previously failed, a glaucoma drainage implant may be recommended. A small silicone tube is inserted into the anterior chamber of the eye and connected to a plate positioned beneath the conjunctiva. The tube channels aqueous humor from inside the eye to the plate, where it is absorbed into surrounding tissue. Drainage implant surgery is performed as an outpatient procedure under local anesthesia and typically takes approximately one hour.
For detailed information about implant types and the procedure, visit our Glaucoma Drainage Implant page.
Minimally Invasive Glaucoma Surgery (MIGS)
MIGS refers to a group of newer surgical techniques designed to lower intraocular pressure with less tissue disruption, faster recovery, and fewer complications than traditional glaucoma surgery. MIGS procedures are typically performed in conjunction with cataract surgery and are best suited for patients with mild to moderate open-angle glaucoma. Common MIGS approaches include micro-bypass stents that create a direct pathway for aqueous humor to reach the eye's natural drainage system. MIGS procedures generally produce a more modest pressure reduction than trabeculectomy or drainage implants but offer a significantly better safety profile.
What to Expect During Glaucoma Surgery
Most glaucoma laser and surgical procedures are performed on an outpatient basis at West Boca Eye Center. Laser procedures (SLT, iridotomy) are typically done in the office with topical anesthetic drops and take less than 15 minutes. Incisional surgeries (trabeculectomy, drainage implant, MIGS) are performed in a surgical suite under local anesthesia with sedation.
General guidelines for all glaucoma procedures:
- Arrange transportation — you will not be able to drive yourself home
- Continue current glaucoma medications unless specifically instructed otherwise
- Expect some temporary blurring, mild discomfort, or light sensitivity after the procedure
- Follow all postoperative instructions regarding eye drops, activity restrictions, and follow-up visits
Recovery After Glaucoma Surgery
- Laser procedures (SLT, iridotomy): Most patients resume normal activities the same day or the following day. Mild inflammation is managed with anti-inflammatory eye drops for several days. Vision typically returns to baseline within 24 to 48 hours.
- Trabeculectomy: Recovery takes several weeks. Activity restrictions (no heavy lifting, bending, or straining) apply for 2 to 4 weeks. Multiple follow-up visits are required to monitor bleb formation and pressure levels. Vision may fluctuate during the healing period.
- Drainage implant: Similar recovery timeline to trabeculectomy. An eye patch is worn initially. Antibiotic and anti-inflammatory drops are prescribed for several weeks. Full pressure stabilization may take 4 to 8 weeks.
- MIGS: Recovery is generally the fastest of the surgical options, particularly when combined with cataract surgery. Most patients return to normal activities within a few days.
Why Choose West Boca Eye Center for Glaucoma Surgery
Dr. Brent Bellotte at West Boca Eye Center provides comprehensive glaucoma care — from initial diagnosis and medication management through laser treatment and surgical intervention. As an ophthalmologist experienced in both laser and incisional glaucoma procedures, Dr. Bellotte determines the most appropriate treatment based on glaucoma type, severity, prior treatment history, and each patient's individual anatomy and lifestyle.
West Boca Eye Center is located at 9325 Glades Road, Suite 201, Boca Raton, FL 33434. Call (561) 488-1001 to schedule your glaucoma evaluation.
Frequently Asked Questions About Glaucoma Surgery
Is glaucoma surgery painful?
Laser procedures are typically painless — you may feel brief pressure or see light flashes during treatment. Incisional surgeries are performed under local anesthesia with sedation, so you will not feel pain during the procedure. Mild discomfort, light sensitivity, and a gritty sensation are common during the first few days of recovery and are managed with prescribed eye drops.
Will I still need eye drops after glaucoma surgery?
Many patients experience a significant reduction in the number of eye drops needed after surgery, and some are able to discontinue drops entirely. However, not all patients achieve complete freedom from medication. The outcome depends on the type and severity of glaucoma, the procedure performed, and how the eye heals. Dr. Bellotte will monitor your pressure closely after surgery and adjust medications accordingly.
How long does glaucoma surgery last?
Laser procedures like SLT typically take less than 10 minutes. Trabeculectomy takes 45 to 60 minutes. Drainage implant surgery takes approximately one hour. MIGS procedures, when combined with cataract surgery, add approximately 10 to 15 minutes to the cataract procedure. All glaucoma surgeries are performed on an outpatient basis — you go home the same day.
Can glaucoma surgery restore lost vision?
No. Vision lost to glaucoma cannot be restored. The goal of glaucoma surgery is to lower intraocular pressure to prevent further optic nerve damage and preserve remaining vision. This is why early detection and treatment are critical — the sooner pressure is controlled, the more vision can be saved.
What is the difference between laser treatment and surgery for glaucoma?
Laser treatments (SLT, iridotomy, cyclophotocoagulation) are less invasive, performed in the office, and have faster recovery. Incisional surgeries (trabeculectomy, drainage implant) involve creating new drainage pathways and are performed in a surgical setting. Laser treatments are often tried first, with incisional surgery reserved for cases where laser treatment and medications are insufficient. MIGS bridges the gap — it is less invasive than traditional surgery but performed in an operating room, typically during cataract surgery.
