Glaucoma surgery lowers eye pressure to protect your optic nerve when drops and laser are not enough. Dr Shibal Bhartiya performs MIGS, trabeculectomy, tube shunts, and revision surgery in Gurgaon.
Glaucoma surgery is not the starting point. When it becomes necessary, the choice of operation and its timing shape how much vision you keep for life.
This page explains glaucoma surgery from a patient’s view. It covers when surgery is needed, how a specialist chooses an operation, what each one involves, and what recovery looks like. It is written for patients in Gurgaon and across Delhi NCR who face surgery, hold a referral, or want a clear answer.
Known for her structured approach to glaucoma risk assessment and progression analysis, Dr Shibal Bhartiya provides trusted second opinions for patients seeking clarity before major treatment decisions. Both, in person, and online.
Most glaucoma treatment starts with eye drops, laser, or both. Surgery becomes necessary when these cannot protect your optic nerve over the long term. Five situations lead to it:
Surgery is not always a last resort. In advanced disease or fast progression, earlier surgery often protects more vision.
Read the full indications for glaucoma surgery and how Dr Bhartiya decides when to recommend surgery. Please also read Avoid Glaucoma Surgery, Myths About Eye Pressure, and Glaucoma Visual Symptoms in Real Life.
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All glaucoma surgery works in one of two ways. It improves drainage of fluid out of the eye, or it reduces fluid production inside the eye. Either way, the goal is to lower pressure to a level that protects the optic nerve.
Surgery does not restore vision already lost. Damage from glaucoma is irreversible. Surgery protects the vision you have. That is why timing matters. Surgery at the right moment saves more vision than surgery that comes too late.
Patients and referring doctors ask this often. The answer is never one size fits all. Both operations lower eye pressure. The difference lies in how much reduction you need, how much risk you accept, and what your disease looks like over decades.
MIGS gives a gentler pressure reduction, with lower risk and faster recovery. It suits mild to moderate disease where modest lowering is enough. It works especially well when you also need cataract surgery.
Trabeculectomy lowers pressure more deeply and for longer. It remains the reference operation when the nerve needs very low pressure to survive. The trade-off is a harder recovery and more complications to manage.
Severity alone does not decide it. A young patient with moderate glaucoma and a low target may do better with trabeculectomy now than with MIGS that falls short in five years. An older patient with less lifetime risk may do well with MIGS and cataract surgery together.
This is why the decision needs a specialist’s assessment, not a formula. Age, stage, rate of progression, target pressure, conjunctival health, and your ability to attend follow-up all count.
If you have been quoted one procedure and feel unsure, a structured glaucoma second opinion before you proceed is reasonable.
MIMIGS is a family of newer procedures. They lower pressure through very small incisions and have a better safety record than traditional surgery. Most use local anaesthesia, many combine with cataract surgery, and recovery is faster.
MIGS suits mild to moderate glaucoma. It suits people who want fewer drops and people who need cataract surgery too. It also suits early disease that keeps progressing despite maximum tolerated medication, and eyes where the risks of trabeculectomy outweigh the benefit.
Different procedures work in different ways. The iStent and Hydrus place a tiny implant that bypasses the trabecular meshwork. The Kahook Dual Blade and Trabectome remove part of the meshwork. The XEN gel stent creates a new drainage route under the conjunctiva.
What MIGS cannot do: it cannot reach the very low pressures that trabeculectomy can. If you have advanced damage and need pressure in the low teens or single digits, MIGS alone is usually not enough.
If you have both conditions, combining phacoemulsification with MIGS is often the logical choice. Cataract surgery alone lowers pressure a little in many eyes. Adding MIGS strengthens the effect. You often need fewer drops afterwards, with one recovery.
SLT is not surgery in the usual sense. It sits between drops and surgery in the treatment path. A laser applied to the drainage angle improves outflow. It works as a first treatment or an add-on, you can repeat it, and it does not rule out later surgery. In early to moderate open-angle glaucoma, SLT can delay or reduce the need for surgery.
Dr Bhartiya has extensive experience in risk stratification and long-term glaucoma care, including hundreds of SLT and LPI procedures.
While not a surgical procedure in the traditional sense, SLT deserves mention here because it sits between drops and surgery in the treatment pathway. It uses a laser applied to the drainage angle to stimulate improved outflow. It is effective as a first-line treatment or adjunct, repeatable, and does not preclude future surgery. For appropriate patients — particularly those with early to moderate open-angle glaucoma — SLT can delay or reduce the need for surgery.
Dr Bhartiya is a glaucoma specialist with extensive experience in risk-stratification and longitudinal glaucoma care, including hundreds of SLT and LPI laser procedures.
Trabeculectomy is the most extensively studied glaucoma operation. It has been in use for over 50 years. When surgeons perform it well and follow it closely, it remains the reference operation when very low pressure is needed.
The surgeon creates a small flap in the wall of the eye, the sclera. Fluid drains through it to just under the conjunctiva and forms a small reservoir called a bleb. The bleb slowly absorbs the fluid and lowers pressure.
An antifibrotic agent, usually Mitomycin C, reduces scarring during surgery. Scarring is the main reason trabeculectomy fails over time. The surgeon matches the dose and exposure time to each patient.
Trabeculectomy is indicated in moderate to advanced glaucoma that needs a large and lasting fall in pressure, beyond what MIGS can reliably give. It also suits these situations:
Some patients stay off drops for years afterwards. Not all do.
Trabeculectomy is effective, but it is not simple. Risks include pressure that falls too low (hypotony), bleb complications, cataract, and infection. Infection of the bleb or inside the eye (blebitis or endophthalmitis) is rare but serious. You may need more treatment if the bleb scars.
This is why patient selection, careful technique, and close follow-up matter, especially in the first weeks.
Surgeon experience matters too. Outcomes depend on the surgeon and on postoperative care. A failing bleb can often be rescued, but only if the surgeon spots it early and acts.
For patients in whom trabeculectomy has failed, or is likely to fail, tube shunts — such as the Ahmed Glaucoma Valve or Baerveldt implant — provide an alternative drainage pathway. A small silicone tube is implanted in the eye, connected to a plate placed on the surface of the eye under the conjunctiva. Fluid drains through the tube to the plate, where it is absorbed.
Tube shunts are used in:
Tube surgery is longer and more involved than trabeculectomy, but it is a valuable and often vision-saving option for patients with complex disease.
In cases where other surgical options are not suitable, cyclodestructive procedures are an option. This includes advanced disease with limited visual potential, or patients who are not candidates for incisional surgery. The ciliary body (which produces aqueous fluid) is treated to reduce fluid production. the most commonly used technique is Diode laser cyclophotocoagulation (DLCP). It is not a first-choice procedure in eyes with good visual potential, but has an important role in selected cases.
Patients ask this most often about glaucoma surgery in Gurgaon. There is no formula. The choice rests on six things. Read also how Dr Bhartiya decides when to recommend surgery.
Severity. Mild disease that needs modest lowering points toward MIGS. Advanced disease that needs very low pressure points toward trabeculectomy. Complex or refractory disease may need a tube.
Age. A 45-year-old needs a solution that lasts decades. A 78-year-old with the same pressure may carry a very different lifetime risk.
Conjunctival health. Trabeculectomy and tube surgery need healthy conjunctiva. Earlier surgery, long use of some drops, or a failed bleb can damage it. The plan must account for this.
Cataract. If you need cataract surgery too, combining it with MIGS is often the most efficient path. If not, more options open up.
Your ability to attend follow-up. Trabeculectomy needs close visits in the first weeks, for bleb care, suture lysis, and checks for low pressure. If you cannot attend, a procedure with a lighter recovery may suit you better.
Surgeon experience. Outcomes depend strongly on the surgeon. An experienced surgeon doing the right operation beats a theoretically ideal operation done rarely.
Each operation has limits. These are the situations where a procedure fits poorly, or where surgery should wait.
If your pressure sits at target and your tests stay steady, surgery adds risk without adding benefit. Read Avoid Glaucoma Surgery.
Many people with glaucoma have a second eye problem. It can change which operation fits and when to do it.
You have a detailed assessment of your glaucoma history, medicines, eye surface, and general health. Dr Bhartiya then explains the plan in full. She covers which procedure, whether to combine it with cataract surgery, whether to use an antifibrotic, and which anaesthesia. You will know exactly what is planned and why.
Some glaucoma drops may continue or change before surgery. Blood thinners may need a pause, agreed with your physician.
Most glaucoma operations use local anaesthesia with sedation and are day procedures. Most people go home the same day. Surgery usually takes 30 to 60 minutes, depending on the procedure. Bring someone to take you home.
The eye is padded. Vision is blurred at first, and the eye may feel uncomfortable. This is normal. You start antibiotic and anti-inflammatory drops straight away. They are essential to the result. You may also continue your glaucoma drops.
After trabeculectomy, the first two to four weeks matter most. Your doctor checks eye pressure, bleb appearance, and chamber depth closely. She may adjust the bleb, with suture lysis or bleb massage, if needed. Do not miss follow-up visits in this period.
MIGS with cataract surgery: most people recover in one to two weeks. Drops continue for several weeks.
Trabeculectomy: functional recovery takes four to twelve weeks, until vision settles and pressure reaches its longer-term level. The bleb keeps maturing for months.
Avoid strenuous activity, swimming, and eye rubbing. How long depends on your procedure, and Dr Bhartiya will tell you.
Glaucoma surgery is not a cure. It lowers pressure. You need lifelong monitoring with OCT, visual fields, and pressure checks. These show whether the disease stays stable and catch late failure early.
Some people stay off drops for years after trabeculectomy. Others restart drops months or years later as the bleb matures or scars. After MIGS, many people continue on fewer drops.
Vision can dip for a while after surgery. Trabeculectomy can speed up cataract. Some eyes need a second operation or a bleb needling. Every operation carries a small risk of infection and of pressure falling too low. Dr Bhartiya explains these risks for your eye before you decide.
Outcomes depend on three things: the right procedure for the right patient, careful technique, and close postoperative care.
If you are considering glaucoma surgery in Gurgaon, ask these questions:
Dr Shibal Bhartiya performs the full range of glaucoma surgery in Gurgaon: MIGS, trabeculectomy, tube shunts, and revision of failed earlier surgery. She manages every surgical patient personally through recovery. She has performed and published on glaucoma surgery outcomes for over two decades.
If you have been told you need surgery, or you are unsure it is the right next step, a structured consultation can help. It includes a review of your existing reports.
No. Glaucoma surgery lowers eye pressure to protect the optic nerve from further damage. It does not reverse damage already done. This is why timing matters.
Most people feel little pain. Your surgeon chooses topical, local, or general anaesthesia. You may feel some aching in the first day or two. Simple painkillers help.
Glaucoma is a lifelong condition. Surgery controls pressure but does not cure the disease. Pressure can rise again over months or years if the drainage pathway scars. You may then need more treatment. This is why long-term follow-up is essential.
Many people keep good pressure control for years. Some need drops again, a bleb needling, or another operation. Dr Bhartiya can tell you what to expect for your eye.
Yes, in selected patients. Combined phacoemulsification and MIGS is well established for mild to moderate glaucoma with cataract. In more advanced glaucoma, the surgeon may combine or stage the operations. Remember, cataract surgery does not protect you from glaucoma.
Needling with antifibrotics can sometimes rescue a failed bleb. If it cannot, revision surgery or a tube shunt is next. This needs glaucoma specialist expertise. Not every surgeon manages complex revisions.
Each operation has its own poor fits. MIGS suits advanced glaucoma badly. Trabeculectomy suits a scarred conjunctiva badly. A tube needs care when the corneal lining is weak. Active infection delays any operation.
Dry eye changes which operation fits. A scarred surface limits trabeculectomy and tube surgery. The surface needs treatment first, or a switch to preservative-free drops. Cataract, retinal disease, uveitis, and corneal disease also shape the plan
Cost depends on the procedure, the implant, the hospital, the anaesthesia, and your follow-up. MIGS with cataract surgery, trabeculectomy, and tube shunts each have a different cost.
Quoting a figure before an examination is not responsible. Surgery should match your stage of disease. An experienced surgeon should perform it, and you must attend early follow-up. Ask for an itemised estimate: surgeon fee, implant, hospital, and follow-up visits.
To learn what surgery suits your eye, and what it will cost, call +91 88826 38735 to book an appointment.
Advised glaucoma surgery in Gurgaon? Bring your reports before you decide. Dr Bhartiya will tell you plainly whether you need surgery, and which operation suits your eye.
Call +91 88826 38735, or upload your reports for review. She also works with your local eye doctor if you live elsewhere.
Dr Shibal Bhartiya consults for glaucoma surgery in Gurgaon. For appointments, contact +91 88826 38735. If you are seeking a second opinion before proceeding with surgery, a structured glaucoma second opinion is available.
This This article was written by Dr Shibal Bhartiya, fellowship-trained glaucoma specialist and Mayo Clinic Research Collaborator, Clinical Director at
Marengo Asia Hospitals, Gurugram, known for ethical, patient-centred glaucoma care and independent glaucoma second opinions. She is also the Program Director for Community Outreach & Wellness; and for the Marengo Asia International Institute of Neuro and Spine.
Dr Bhartiya has published peer-reviewed research on glaucoma management, examining how treatment decisions should balance medical
evidence, patient preferences, and long-term vision outcomes. She is also a committed patient advocate and mainstream medical columnist, translating complex ophthalmic evidence into actionable public health insights across leading national platforms including NDTV and OnlyMyHealth
As Editor-in-Chief of Clinical and Experimental Vision and Eye Research and Executive Editor of the Journal of Current
Glaucoma Practice (Pubmed Indexed, official journal of the International Society of Glaucoma Surgery). Her 200+ publications, including 90+ PubMed indexed publications and 28 edited textbooks span glaucoma biology, surgical outcomes, health equity, and emerging diagnostics.
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Last Reviewed: October 2026
These peer-reviewed articles discussing Glaucoma Surgeries can be accessed on PubMed here, here, here, and here (for MIGS); and here, here, here and here for conventional glaucoma surgeries ( trabeculectomy, NPDS and tubes/ glaucoma shunts)
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