Glaucoma care · San Antonio

Glaucoma treatment and MIGS surgery in San Antonio

Glaucoma damages the optic nerve, usually because fluid inside the eye doesn't drain well and pressure builds. Every glaucoma treatment works by lowering that pressure, either by making less fluid or by helping it drain. As a fellowship-trained glaucoma specialist, Dr. Kavanagh has performed every type of MIGS procedure and traditional glaucoma surgery, so your treatment is matched to your glaucoma rather than to the tools a surgeon happens to use.

Call 830-379-3937 Book a glaucoma evaluation

Fluid leaves the eye through the drainage angle. Each procedure below improves a different part of this system.

Jump to a procedure

SLT laser Durysta iDose TR iStent infinite Hydrus Microstent AlloFlo Uveo XEN Gel Stent Trabeculectomy Ahmed valve & seton surgery

Compare glaucoma procedures

Procedure	Type	Where it works	Setting	With cataract surgery?
SLT laser	Laser	Trabecular meshwork (natural drain)	In office, about 5–10 minutes	Not needed
Durysta	Drug implant	Inside the eye's front chamber	Office procedure	Not needed
iDose TR	Drug implant	Anchored in the drainage angle	Surgery center	Can be done alone or with cataract surgery
iStent infinite	MIGS stent	Trabecular meshwork into Schlemm's canal	Surgery center	Can be done alone or with cataract surgery
Hydrus Microstent	MIGS stent	Schlemm's canal (scaffolds about 90 degrees)	Surgery center	Performed with cataract surgery
AlloFlo Uveo	MIGS, uveoscleral	Supraciliary space (uveoscleral pathway)	Surgery center	Performed as a standalone procedure
XEN Gel Stent	MIGS, subconjunctival	From the front chamber to under the conjunctiva	Surgery center	Can be done alone or with cataract surgery
Trabeculectomy	Traditional glaucoma surgery	New drain under a scleral flap into a bleb	Surgery center or hospital	Usually separate
Ahmed valve & seton surgery	Tube shunt	Tube in the eye drains to a plate on the sclera	Surgery center or hospital	Usually separate

For educational purposes. The right procedure depends on your type and stage of glaucoma.

Where it works: Trabecular meshwork (natural drain)

View through a gonioscopy lens during SLT laser, with the red aiming beam on the drainage angle

LaserIn office, about 5–10 minutes

Selective laser trabeculoplasty (SLT)

SLT uses short pulses of low-energy laser light on the trabecular meshwork, the eye's natural drain. The laser stimulates the body's own repair process so fluid drains more easily.

The procedure

Numbing drops are placed and a special contact lens rests on the eye
The laser is applied around the drainage angle in a few minutes
You go home the same day and resume normal activities

Often a good fit for

Newly diagnosed open-angle glaucoma, patients who want to reduce or avoid daily drops, and those who have trouble with drops or their side effects. Large studies support SLT as a first-line treatment.

The effect can fade over years, and SLT can be repeated.

Where it works: Inside the eye's front chamber

A Durysta implant resting in the drainage angle of the eye

Drug implantOffice procedure

Durysta (bimatoprost implant)

Durysta is a tiny, dissolvable implant that slowly releases bimatoprost, a common glaucoma medication, from inside the eye. It lowers pressure without daily drops for months in many patients.

The procedure

The eye is numbed and cleaned
The implant is placed in the front chamber with a fine applicator
The implant gradually dissolves as it releases medication

Often a good fit for

Patients with open-angle glaucoma or ocular hypertension who struggle with daily drops, forget doses or have drop side effects.

Not suitable for every eye, including some with corneal problems. Dr. Kavanagh checks your cornea first.

Where it works: Anchored in the drainage angle

Gonioscopic view of an iDose TR implant anchored in the drainage angle

Drug implantSurgery center

iDose TR (travoprost intracameral implant)

iDose TR is a tiny titanium implant anchored in the eye's drainage tissue. It continuously releases travoprost, a proven glaucoma medication, directly inside the eye for an extended period, reducing or eliminating the need for daily drops.

The procedure

Performed through a tiny incision at the edge of the cornea
The implant is anchored in the wall of the drainage angle
It can be placed during cataract surgery or as its own procedure

Often a good fit for

Patients with open-angle glaucoma or ocular hypertension who want a long-lasting alternative to daily drops.

It treats with medication rather than creating a new drain, so it pairs well with MIGS stents.

Where it works: Trabecular meshwork into Schlemm's canal

Gonioscopic view showing iStent infinite stents alongside an iDose TR implant

MIGS stentSurgery center

iStent infinite trabecular micro-bypass

iStent infinite places three heparin-coated titanium micro-stents through the trabecular meshwork into Schlemm's canal. Each stent opens a bypass through the blocked drain, and spreading three stents around the angle reaches more of the eye's collector channels.

The procedure

Performed through a tiny corneal incision using a microscope and gonioscopy lens
A preloaded injector places three stents in one pass
Recovery is quick, usually with drops for a few weeks

Often a good fit for

Open-angle glaucoma not controlled by medication or prior surgery. It is FDA-approved as a standalone procedure, so it does not require cataract surgery.

The stents are among the smallest implants in medicine; you will not feel them.

Where it works: Schlemm's canal (scaffolds about 90 degrees)

MIGS stentSurgery center

Hydrus Microstent

The Hydrus is an 8 mm flexible nitinol scaffold that sits inside Schlemm's canal, holding the canal open across roughly a quarter of the eye's circumference while bypassing the trabecular meshwork. Dr. Kavanagh was the first surgeon in South Texas to implant the Hydrus.

The procedure

Placed through the same small incision used for cataract surgery
The scaffold is guided into Schlemm's canal under direct view
Healing is typically quick, similar to cataract surgery alone

Often a good fit for

Mild to moderate open-angle glaucoma in patients having cataract surgery. Long-term studies show lower pressure and fewer medications compared with cataract surgery alone.

Because it is placed with cataract surgery, it adds little recovery time.

Where it works: Supraciliary space (uveoscleral pathway)

MIGS, uveoscleralSurgery center

AlloFlo Uveo (supraciliary bio-tissue spacer)

Most MIGS procedures work on the trabecular drain. AlloFlo Uveo works on the eye's other natural outflow route, the uveoscleral pathway. A small, controlled opening is made between the ciliary body and the sclera, and tiny spacers made of processed donor scleral tissue are placed to keep that space open so fluid can drain.

The procedure

Performed as its own procedure, separate from cataract surgery
Done through a small incision from inside the eye
A gentle separation is created between the ciliary body and the sclera (a cyclodialysis)
Donor-tissue spacers are inserted to keep the new pathway open

Often a good fit for

Open-angle glaucoma, including patients whose earlier trabecular procedures have lost effect.

AlloFlo uses natural, collagen-rich tissue rather than a synthetic implant.

Where it works: From the front chamber to under the conjunctiva

MIGS, subconjunctivalSurgery center

XEN Gel Stent

The XEN Gel Stent is a soft, 6 mm tube made of gelatin that creates a new drainage channel from inside the eye to the space under the conjunctiva, the clear skin over the white of the eye. Fluid collects there in a small reservoir called a bleb and is absorbed. It lowers pressure more than trabecular MIGS, with less tissue disruption than a trabeculectomy.

The procedure

The stent is placed through a tiny incision, usually from inside the eye
A medication (mitomycin C) is used to reduce scarring
Follow-up visits are more frequent early on, and some eyes need a minor in-office adjustment of the bleb

Often a good fit for

Glaucoma that remains uncontrolled despite medications or earlier surgery, when a lower target pressure is needed.

Because it forms a bleb, you will have more follow-up visits in the first months.

Where it works: New drain under a scleral flap into a bleb

Traditional glaucoma surgerySurgery center or hospital

Trabeculectomy

Trabeculectomy has been the gold standard for lowering eye pressure for decades. A small, protected opening is created in the wall of the eye under a trap-door flap of sclera. Fluid drains through it into a bleb under the conjunctiva, often achieving the lowest pressures of any glaucoma surgery.

The procedure

Performed in the operating room with anesthesia so you are comfortable
A partial-thickness flap is made in the sclera and a small opening is created beneath it
Sutures control the flow and can be adjusted after surgery; frequent follow-up is needed early on

Often a good fit for

Advanced or rapidly progressing glaucoma, and eyes needing very low pressure.

Lifelong awareness matters: call right away for a red, painful eye or discharge after a trabeculectomy.

Where it works: Tube in the eye drains to a plate on the sclera

An eye with an Ahmed glaucoma valve tube visible inside the front chamber

Tube shuntSurgery center or hospital

Ahmed glaucoma valve and tube shunts (seton surgery)

A tube shunt, also called a seton, places a thin silicone tube into the eye that carries fluid to a small plate secured on the outer wall of the eye, behind the eyelid. The Ahmed valve includes a pressure-sensitive valve that helps prevent pressure from dropping too low right after surgery. Dr. Kavanagh was the first ophthalmologist to perform seton surgery in Seguin.

The procedure

Performed in the operating room
The plate is secured to the sclera under the conjunctiva and the tube is placed into the eye
The tube is covered with a patch graft for protection

Often a good fit for

Advanced, complex or hard-to-control glaucoma, including neovascular and uveitic glaucoma and eyes where earlier surgery has failed.

Many patients still use some drops afterward, usually fewer than before.

Questions

Glaucoma treatment questions

Which glaucoma procedure is right for me?

It depends on the type and stage of your glaucoma, your target pressure, whether you need cataract surgery and how well you tolerate drops. Dr. Kavanagh reviews your optic nerve scans, visual fields and pressure history to recommend a plan.

Will I still need eye drops?

Many patients use fewer drops after a procedure, and some stop entirely. The goal is the right pressure for your optic nerve with the fewest burdens.

Can glaucoma damage be reversed?

No. Vision already lost to glaucoma cannot be restored, which is why early diagnosis and steady pressure control matter so much.

What is MIGS?

Minimally invasive glaucoma surgery: procedures performed through tiny incisions, often with cataract surgery, that improve drainage with faster recovery than traditional surgery.

For educational purposes. This page explains glaucoma treatments to help you prepare for your visit. Your exam determines the right plan for your eyes.

Protect your vision. See a glaucoma specialist in San Antonio.

Call 830-379-3937 Book an appointment