A surgical procedure that creates a new drainage pathway for fluid to leave the eye, generally lowering pressure more than MIGS.

When might Dr. Puja Sheth recommend trabeculectomy? Usually for more advanced glaucoma, or when other treatments haven't brought pressure down to a safe level. It's often the next step when MIGS wouldn't be expected to lower pressure enough on its own — the decision comes down to how advanced the glaucoma is and what pressure target the eye actually needs, which is assessed individually rather than by a fixed rule.

The surgeon creates a small flap in the eye's outer wall (the sclera), allowing fluid to drain into a reservoir under the eye's surface, where it's gradually absorbed. Mitomycin-C (MMC), an antimetabolite, is typically applied during surgery to reduce scarring at the drainage site — scarring is the main reason this type of surgery can lose effectiveness over time, so MMC is used to help the new drainage pathway stay open longer.

Performed as same-day surgery. Recovery involves a period of controlled healing, monitored closely, since how the drainage site heals affects the surgery's long-term outcome.

More frequent follow-up visits than MIGS in the weeks after surgery, since adjustments are sometimes needed during healing. Full recovery generally takes some weeks, though this varies by case.