{"id":1996,"date":"2026-10-20T08:55:07","date_gmt":"2026-10-20T08:55:07","guid":{"rendered":"https:\/\/laseristanbulclinic.com\/eye-health\/retina-glaucoma\/trabeculectomy-vs-trabeculotomy-vs-migs\/"},"modified":"2026-10-20T12:59:53","modified_gmt":"2026-10-20T12:59:53","slug":"trabeculectomy-vs-trabeculotomy-vs-migs","status":"publish","type":"page","link":"https:\/\/laseristanbulclinic.com\/en\/eye-health\/retina-glaucoma\/trabeculectomy-vs-trabeculotomy-vs-migs\/","title":{"rendered":"Selective Laser Trabeculoplasty vs Trabeculectomy, Trabeculotomy and MIGS: Which Glaucoma Operation?"},"content":{"rendered":"\n
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  4. Selective Laser Trabeculoplasty vs Trabeculectomy, Trabeculotomy and MIGS: Which Glaucoma Operation?<\/span><\/li><\/ol><\/div>\t\t\t

    Selective Laser Trabeculoplasty vs Trabeculectomy, Trabeculotomy and MIGS: Which Glaucoma Operation?<\/h1>\n\t\t\t\t\t\t

    Selective laser trabeculoplasty vs trabeculectomy is rarely a straight either-or: the two are usually used at different stages of glaucoma. This guide compares all four options (SLT laser, MIGS, trabeculotomy and trabeculectomy) in plain English: what each one does, who it suits, what the studies show and what can go wrong.<\/p>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t

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    Selective laser trabeculoplasty (SLT) is a gentle laser used early. MIGS (micro-stents or small drainage cuts, usually added to cataract surgery) suits mild to moderate glaucoma. Trabeculotomy opens the eye’s own drain with no bleb. Trabeculectomy builds a new drain and lowers pressure the most, so it is used for advanced or uncontrolled glaucoma, but it needs the most aftercare. Prof. Dr. Ahmet Sat\u0131c\u0131 helps match the operation to your stage.<\/p><\/div>\n\t\t\t\t\t<\/div>\n\t<\/div><\/div>\n<\/section>\n\n\n\n\n

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    How do the four glaucoma operations compare at a glance?<\/h2>\n\t\t\t

    All four aim to do the same thing: lower the pressure inside the eye so the optic nerve is damaged more slowly. They differ in how much they lower it, how invasive they are and how long recovery takes. Glaucoma UK describes the usual route as moving from drops, through laser, to more invasive surgery as needed.<\/p>\n\t\t\t

    <\/th>SLT laser<\/th>MIGS (micro-stents, goniotomy)<\/th>Trabeculotomy (ab externo, GATT)<\/th>Trabeculectomy<\/th><\/tr><\/thead>
    What it does<\/th>Laser stimulates the eye’s own drain; no cut<\/td>Tiny stent or small cut improves flow through the eye’s own drain<\/td>Opens the drain’s canal (Schlemm’s canal) from outside or inside the eye<\/td>Creates a new, guarded drain under a scleral flap that empties into a bleb<\/td><\/tr>
    Bleb?<\/th>No<\/td>No (except subconjunctival devices)<\/td>No<\/td>Yes, for life<\/td><\/tr>
    Typical stage<\/th>Newly diagnosed, not advanced; ocular hypertension<\/td>Mild to moderate, often with cataract surgery<\/td>Childhood glaucoma; selected adults<\/td>Moderate to advanced, or drops and laser not enough<\/td><\/tr>
    Pressure effect<\/th>About 20\u201330% lower (5\u20138 mmHg)<\/td>Moderate; the trial benchmark is at least 20%<\/td>Moderate to good in selected adults<\/td>Largest; a mean of 12.4 mmHg at one year in a major trial<\/td><\/tr>
    Recovery<\/th>Usually back to normal life next day<\/td>Days<\/td>Days to weeks<\/td>Weeks of check-ups<\/td><\/tr>
    Main downside<\/th>Effect fades over years; can be repeated<\/td>Usually not enough for advanced disease<\/td>Bleeding in the eye is common (usually clears)<\/td>Most complications; lifelong bleb care<\/td><\/tr><\/tbody><\/table><\/div>

    Figures are from the studies cited below; your own result depends on your eye, your stage and your surgeon.<\/p><\/div>\t<\/div><\/div><\/div><\/section>\n\n\n\n\n

    Selective laser trabeculoplasty vs trabeculectomy: which comes first?<\/h2><\/div>

    SLT usually comes first and trabeculectomy later, because they treat different stages: SLT is a gentle laser for early glaucoma, while trabeculectomy is a surgical operation for glaucoma that is advanced or not controlled.<\/p>\n

    SLT in brief.<\/strong> According to EyeWiki, the American Academy of Ophthalmology’s clinical encyclopedia, SLT uses a 3-nanosecond laser pulse to stimulate pigmented cells in the eye’s drainage meshwork. It typically lowers pressure by 20\u201330% (about 5\u20138 mmHg). It can be repeated: in one study quoted by EyeWiki, repeat SLT kept pressure controlled without drops in 67% of 115 eyes at 18 months. The effect does fade, though: EyeWiki quotes success rates of 68% at one year, 46% at three years and 32% at five years. Side effects are mostly short-lived: a pressure spike above 5 mmHg in about 10% of eyes even with preventive treatment, mild inflammation, and rarely small adhesions in the drainage angle (1.1%).<\/p>\n

    Why SLT is often offered first.<\/strong> In the UK LiGHT trial of 718 untreated patients, 74.2% of those treated with SLT first needed no drops at three years. After six years, 69.8% of SLT eyes were still at target pressure without drops or surgery, fewer SLT eyes progressed (19.6% vs 26.8%), and far fewer needed a trabeculectomy (13 eyes vs 32 in the drops-first group). NICE guideline NG81 recommends SLT as first-line treatment for newly diagnosed open-angle glaucoma that is not advanced and for ocular hypertension, as summarised by the College of Optometrists; people with pigment dispersion syndrome are excluded.<\/p>\n

    When SLT is not enough.<\/strong> SLT is not suitable for every eye. EyeWiki lists active uveitis, neovascular glaucoma, iridocorneal endothelial syndrome and angle-closure with adhesions among the contraindications. And when glaucoma is advanced, or pressure stays above target after drops and laser, doctors move to surgery. That is the point where trabeculectomy, trabeculotomy and MIGS are compared.<\/p>\n

    Not an either-or.<\/strong> Having SLT does not rule out surgery later, but the LiGHT results suggest it makes it less likely. If you are weighing SLT against trabeculectomy, the real question is: what pressure does my optic nerve need, and has a gentler step already been tried?<\/em><\/p><\/div><\/div><\/div><\/div><\/div><\/section>\n\n\n\n\n

    What is MIGS, and who is it for?<\/h2><\/div>

    MIGS (minimally invasive glaucoma surgery) is a group of small, quick operations done through a tiny corneal incision, which lower pressure modestly with a lower risk of serious complications than trabeculectomy. EyeWiki gives five defining features: a high safety profile, minimal disruption to the eye’s anatomy, an approach from inside the eye (ab interno), a meaningful pressure-lowering effect (at least a 20% reduction or one fewer medication) and quick recovery that fits with cataract surgery.<\/p>\n

    Main types of MIGS<\/strong> (EyeWiki, with FDA approval years):<\/p>\n