What is glaucoma and why might surgery be necessary?

Glaucoma is a progressive disease that damages the optic nerve, usually because the pressure inside the eye becomes too high. Once the nerve fibres are lost, the damage is irreversible. Glaucoma surgery (sometimes also called a glaucoma operation) is recommended when medication and laser therapy no longer provide enough pressure control.

Typical indications for glaucoma surgery include:

• progressive optic nerve damage on examination or OCT,
• deteriorating visual fields despite treatment,
• ineffective pressure control with drops or laser,
• high risk of further vision loss, especially if one eye is already badly affected.

The aim of glaucoma surgery is not to restore lost sight but to stabilise the disease and protect the remaining visual field for as long as possible.

Glaucoma surgery: when is it necessary?

At the Munich Center for Eye Surgery, the decision for or against glaucoma surgery is always based on a thorough diagnostic work-up and an individual risk–benefit assessment. Your ophthalmic surgeon considers:

• the current level and fluctuation of intraocular pressure (IOP),
• the condition of the optic nerve on clinical examination and OCT imaging,
• visual field results and how quickly they change,
• your age, general health and other eye conditions (for example cataract),
• how well you tolerate eye drops and whether you can use them reliably.

If the risk of further damage is high, your surgeon will discuss whether glaucoma surgery, a combined cataract–glaucoma procedure, or a minimally invasive glaucoma surgery (MIGS) is the most suitable option for you.

Types of glaucoma surgery we perform

Modern glaucoma surgery at the Munich Center for Eye Surgery includes several procedures. They differ in how invasive they are, how quickly patients recover and how strong the pressure-lowering effect is.

Trabeculectomy

Trabeculectomy is considered the gold standard in glaucoma surgery. A tiny drainage channel is created under the upper eyelid to allow fluid to exit the eye more easily, which lowers intraocular pressure over the long term.

A small filtering bleb forms under the eyelid, where the fluid is absorbed by the surrounding tissue. Trabeculectomy is highly effective and often used in moderate to advanced glaucoma.

Tube shunt (drainage implant)

In some patients, a small silicone tube is implanted into the eye. Fluid flows through the tube to a plate placed under the conjunctiva, where it is absorbed. This type of glaucoma surgery is particularly useful:

• when trabeculectomy is not suitable,
• when previous surgery has failed,
• for certain complex or secondary glaucomas.

MIGS (Minimally Invasive Glaucoma Surgery)

MIGS procedures use micro-stents or small instruments to improve the natural outflow of fluid from within the eye. They are performed through very small incisions and are often combined with cataract surgery. MIGS is particularly attractive for patients with early to moderate glaucoma, where the goal is to reduce eye pressure and medication burden with a shorter recovery time.

Many patients with glaucoma also have cataracts. In these cases we often perform a combined cataract and glaucoma surgery during one operation. For early stages of glaucoma, minimally invasive glaucoma surgery (MIGS) can be an attractive option with a shorter recovery time.

Preparing for your glaucoma surgery

The Munich Center for Eye Surgery performs a full diagnostic assessment before recommending glaucoma surgery. This includes OCT imaging, visual fields, pressure curves and a detailed medical review.

After glaucoma surgery, you can expect:

• temporary blurred vision,
• anti-inflammatory and antibiotic drops,
• activity restrictions for a limited period,
• scheduled follow-up visits to monitor healing and eye pressure.

For early glaucoma, our team may also discuss laser options and other eye surgery services in Munich that may be relevant to your overall eye health.

Risks and long-term outlook of glaucoma surgery

Like any eye operation, glaucoma surgery involves risks. Serious complications are rare, but it is important to understand them and to react early if symptoms appear.

Possible complications include:

• infection inside the eye,
• bleeding,
• scarring that reduces the drainage effect,
• eye pressure that becomes too low (hypotony),
• temporary or persistent blurred vision.

In most patients, glaucoma surgery significantly lowers eye pressure and slows or stops further damage to the optic nerve. Many people still need glaucoma drops after surgery, but often fewer than before. The key message is that the earlier unstable glaucoma is treated surgically, the higher the chance of preserving useful vision and maintaining independence in everyday life.

Why choose the Munich Center for Eye Surgery?

• Experienced glaucoma surgeons: specialists with many years of experience in glaucoma surgery and laser treatment.
• Modern diagnostics and MIGS technology: up-to-date imaging, laser systems and minimally invasive procedures.
• Clear communication in English: explanations in understandable language for international patients.
• Fast appointment scheduling: short waiting times for diagnostic work-up and surgery.
• Full support for international patients: assistance with travel, accommodation and medical reports if required.

Further background information on glaucoma surgery is available from the National Eye Institute (NIH) and the Glaucoma Research Foundation.

New and emerging methods in glaucoma surgery

Glaucoma surgery has changed significantly in recent years. Traditional procedures such as trabeculectomy and drainage implants remain highly effective, but new technologies now allow safer, gentler and more predictable pressure reduction. Below is an overview of modern innovations that are increasingly used in Europe and worldwide.

Next-generation MIGS (Minimally Invasive Glaucoma Surgery)

Modern implants such as the Hydrus Microstent, iStent Inject W and Xen Gel Stent provide targeted outflow enhancement with minimal trauma. These procedures are ideal for early and moderate glaucoma and can be combined with cataract surgery for even better outcomes.

Ab-interno canaloplasty (ABiC)

A newer, minimally invasive form of canaloplasty performed from inside the eye. It restores the natural drainage pathway without creating an external bleb and has a very favourable safety profile. Recovery is usually faster compared to traditional angle surgery.

Micropulse laser trabeculoplasty

This advanced laser treatment uses short, low-energy pulses to stimulate the trabecular meshwork without causing thermal damage. It can be repeated safely and is increasingly used before choosing more invasive procedures.

Preserflo™ MicroShunt

A newer generation shunt designed to provide controlled, predictable drainage with fewer complications than older implants. Clinical studies in Europe show stable pressure reduction and less need for post-operative interventions.

Endoscopic cyclophotocoagulation (ECP)

ECP targets the ciliary body to reduce aqueous fluid production from inside the eye. It is often combined with cataract surgery and is a valuable alternative when conventional treatments are insufficient.

AI-assisted decision-making

Artificial intelligence tools are now used to analyse optic nerve scans, predict glaucoma progression and help select the optimal surgical method. Although still under development, AI is becoming an important part of personalised glaucoma care.

These new techniques do not replace traditional glaucoma surgery, but they provide additional options—especially for patients with early or moderate disease, those with poor tolerance to medication or individuals needing faster recovery.

FAQs on glaucoma surgery

Is glaucoma surgery painful?

Glaucoma surgery is usually performed under local anaesthesia with sedation, so you should not feel pain during the procedure. After surgery the eye may feel scratchy or irritated for a few days, but severe pain is uncommon.

How long does it take to recover from glaucoma surgery?

Recovery after glaucoma surgery depends on the procedure. Minimally invasive glaucoma surgery (MIGS) often allows a return to normal activities within days, while trabeculectomy and tube shunt surgery usually require several weeks of healing and follow-up visits.

Can glaucoma surgery restore lost vision?

No. Glaucoma surgery cannot restore nerve fibres that have already been damaged. The goal is to lower intraocular pressure, slow or stop further damage and protect the remaining vision.

Will I still need eye drops after glaucoma surgery?

Many patients continue to use glaucoma eye drops after surgery, although often fewer than before. Whether you need drops and which ones is decided individually during follow-up appointments.

How can I arrange glaucoma surgery in Munich?

You can arrange glaucoma surgery at the Munich Center for Eye Surgery by calling the clinic or sending an appointment request via the contact form. Bringing previous eye reports, visual field tests and a list of current medications allows the surgeon to assess your case more precisely.

Author and medical review

This information on glaucoma surgery was written and medically reviewed by Prof. Dr. [Name Surname], consultant ophthalmic surgeon at the Munich Center for Eye Surgery.

Last medical review: November 2025.

Arrange your glaucoma surgery consultation in Munich

Early evaluation is essential when medication is no longer enough. Our surgeons will explain your options and create a safe, personalised plan to protect your remaining vision.

Munich Center for Eye Surgery
Nymphenburger Straße 43, 80335 Munich, Germany
Phone: +49 176 7223 7999