Glaucoma Treatment: From Basic Interventions to Advanced Surgical Procedures with a Special Focus on Emerging Surgical Techniques

Abstract

The management of glaucoma requires a tiered, patient-specific approach, beginning with pharmacological therapy and progressing to laser and surgical interventions when medical treatment is insufficient(83, 91. Topical medications remain the first-line option for early-stage glaucoma, particularly prostaglandin analogues, which offer effective intraocular pressure (IOP) reduction (82). However, adherence issues and side effects limit real-world efficacy, highlighting the importance of both combination therapies and alternative delivery systems (84, 87). Selective laser trabeculoplasty (SLT) has emerged as a viable first-line or adjunctive treatment that reduces IOP with a favorable safety profile (93–95). For more advanced or refractory cases, traditional surgical techniques, including trabeculectomy and glaucoma drainage devices, provide substantial long-term IOP control (187, 188), albeit with higher complication risks (160,162). The advent of minimally invasive glaucoma surgery (MIGS) has offered an intermediate option—balancing safety and efficacy in patients with mild to moderate disease (164–166). Emerging technologies—such as gene therapy, neuroprotective agents, artificial intelligence (AI), robotics, and smart drug-delivery implants—demonstrate promising potential to transform the treatment landscape (168–186. While these modalities are still in developmental or early clinical stages, they collectively represent a shift toward precision and neuroprotective glaucoma care.