Ophthalmology · London
Glaucoma surgery in London, by a subspecialist consultant.
Indicative pricing
What private glaucoma surgery costs in London.
Indicative ranges across UK private providers.
In short
£3,000–£6,000 per eye, home the same day.
| Procedure | Indicative range | Typical duration | Recovery |
|---|---|---|---|
| Trabeculectomy with mitomycin-C (per eye) | £3,000–£6,000 | 45–60 min | Same visit |
| Tube shunt (Baerveldt / Ahmed / PAUL) | £4,000–£8,000 | 60–90 min | Same visit |
| MIGS with phaco (iStent inject W, Hydrus) | £2,000–£4,000 | +10 min | Same visit |
| XEN Gel Stent (subconjunctival MIGS) | £3,500–£5,500 | 30 min | Same visit |
| Preserflo MicroShunt | £4,000–£6,500 | 30–45 min | Same visit |
| Consultation with visual fields and OCT | £350–£600 | 60 min | Same visit |
Prices vary by clinic, by consultant, by device (Baerveldt vs Ahmed vs PAUL; iStent vs Hydrus vs XEN vs Preserflo), and by whether cataract surgery is done at the same visit.
The problem
The right surgeon, the right operation, the right time.
Glaucoma surgery is one of the least standardised areas in private ophthalmology - a MIGS-only cataract surgeon may under-treat, and an unfamiliar surgeon may pick the wrong tube. We fix the matching before you book.
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Progressing despite drops?
If the field is worsening at target IOP, MIGS is not enough - you need filtration surgery.
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Been offered a MIGS and unsure?
Right for mild-moderate disease with cataract. Wrong for advanced or fast-progressing glaucoma.
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Had a failed trabeculectomy?
A tube shunt (Baerveldt, PAUL) is usually the answer - done by a surgeon who does them every week.
When it helps
When glaucoma surgery is the right step.
The situations we see most, plus the one red flag that means an emergency rather than an appointment.
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Progressing on maximum drops
Disc or visual-field progression despite three or four topical agents at target IOP - surgery is the next step.
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SLT and laser have failed
Selective laser trabeculoplasty was inadequate or has worn off, and target IOP is still not being met.
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Intolerance or non-compliance
Ocular surface disease, allergy or poor adherence to drops - a one-off procedure is often the kinder answer.
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Pseudoexfoliation or pigmentary glaucoma
High-pressure phenotypes that often need surgical filtration sooner rather than later.
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Uveitic or neovascular glaucoma
Refractory glaucoma with inflammation or new vessels - usually a tube shunt rather than trabeculectomy.
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Cataract plus mild-moderate glaucoma
A perfect moment to add MIGS (iStent inject W, Hydrus) to phacoemulsification - 20–30% IOP reduction.
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Chronic angle-closure
Angles closed despite iridotomy and lens extraction - filtration or a tube may still be needed.
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Red flag: acute pain, halos, nausea
Acute angle-closure with sudden pressure spike is an emergency - same-day eye A&E, not a clinic booking.
Procedure options
Trabeculectomy is not the only option.
What each option on the table actually involves - and which fits which stage of disease.
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Trabeculectomy with MMC
The gold-standard filtration procedure - a scleral flap and sclerostomy drain aqueous under the conjunctiva to a bleb. Best 5-year IOP control.
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Baerveldt tube shunt
A large-plate silicone tube for refractory glaucoma, prior failed trabs, uveitic or neovascular disease. Ligature opens at 6–8 weeks.
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Ahmed valved tube
A valved shunt - less early hypotony risk, useful when a fast pressure drop is needed.
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PAUL glaucoma implant
A newer small-footprint tube gaining ground in the UK - thinner tube, lower hypotony risk than Baerveldt in trials.
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iStent inject W / Hydrus
Trabecular MIGS placed at cataract surgery - 20–30% IOP reduction and one or two fewer drops. Mild-moderate disease.
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XEN Gel Stent
A soft gelatin subconjunctival stent - MIGS-adjacent, creates a small bleb, an alternative to a full trabeculectomy for the right eye.
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Preserflo MicroShunt
An ab-externo subconjunctival shunt with MMC - trabeculectomy-like IOP reduction with a shorter, standardised technique.
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Consultation only
Fields, OCT-RNFL, disc photos and gonioscopy - an honest opinion on whether surgery is needed yet, and which one.
Safety and recovery
What to expect afterwards - honestly.
Glaucoma surgery is safe in expert hands but demanding in the first three months, and the risk of bleb-related infection is lifelong. Knowing what is normal, and what is not, matters more than for most operations.
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Hypotony is the early worry
A soft eye, a flat anterior chamber and choroidal effusion can occur in the first weeks. Releasable sutures and viscoelastic reformation manage most cases.
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Endophthalmitis is the lifetime worry
Bleb-related infection can occur years later with MMC blebs - 0.5–2% lifetime risk. Any red, painful, blurred eye is an emergency, forever.
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Blebitis 3–5% and needs same-day care
A red, gritty eye with a milky bleb is blebitis - intensive antibiotics, seen the same day, prevents progression to endophthalmitis.
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Vision blurs for 6–12 weeks
Astigmatism from the flap and pressure fluctuation cause fluctuating, blurry vision for two to three months. It settles.
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Cataract may progress
A trabeculectomy in a phakic eye speeds cataract formation. Many patients need phaco within a couple of years.
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Tube shunts have their own pattern
Tube exposure, corneal endothelial loss and diplopia are the tube-specific risks. Patch graft covers the tube from day one.
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MIGS is safer but does less
Trabecular MIGS is quick and low-risk, but drops IOP 20–30% rather than 30–40%. Wrong tool for advanced disease.
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Bleb dysaesthesia is real
Some patients feel the bleb - a foreign-body sensation with blinking. Bleb revision helps in stubborn cases.
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Red flags
Sudden pain, sudden drop in vision, a red painful eye, or discharge from the bleb are all reasons for same-day ophthalmic review.
Reading your operation note
Your operation note in four parts. Read the last one first.
Whichever technique was used, the note the surgeon sends you keeps to the same shape.
A quiet reminder
Surgical language is precise and can read coldly - we translate it for you.
If you would like us to talk you through the note before your review, just ask.
- 01 Header
Diagnosis, eye, target IOP
Type of glaucoma, which eye, pre-op IOP, target IOP set for your disc and field, and the procedure chosen.
- 02 Technique
Flap, MMC, sutures, tube or stent
Fornix- or limbal-based flap, MMC concentration and duration, number of releasable sutures, or the tube model and plate location.
- 03 Findings
Intra-op notes and any complications
Bleb formation, anterior chamber depth at closure, any bleeding or vitreous, and iridectomy patency.
- 04 Impression
Drop regimen, review timing, red flags
Read this first: which glaucoma drops to stop, the steroid taper, when to be seen next, and what to phone for.
Recognised by major UK insurers
Cover for glaucoma surgery is almost always funded when medically indicated. Devices (Preserflo, XEN, PAUL) may need pre-authorisation.
Frequently asked
Everything we get asked about glaucoma surgery.
Quick answers on trabeculectomy vs MIGS, tube shunts, mitomycin-C, recovery, and long-term risk.
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Why would I need glaucoma surgery when drops are working?
Drops "working" is not the same as reaching target IOP. If your visual field or optic nerve is still progressing, or if you cannot tolerate the drops, filtration surgery is the next step - usually trabeculectomy or a tube shunt.
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Trabeculectomy or MIGS - which is right for me?
Trabeculectomy achieves 30–40% IOP reduction and suits moderate-to-advanced disease. MIGS (iStent inject W, Hydrus) drops IOP 20–30% and is added to cataract surgery for mild-moderate disease. A glaucoma consultant will match the procedure to your stage.
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When is a tube shunt preferred over a trabeculectomy?
Tubes (Baerveldt, Ahmed, PAUL) are preferred for refractory glaucoma, previous failed trabeculectomy, uveitic or neovascular glaucoma, and often for older patients or heavily scarred conjunctiva. Younger phakic eyes usually do better with a first-line trabeculectomy.
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How much does private glaucoma surgery cost in London?
Roughly £3,000–£6,000 per eye for trabeculectomy, £4,000–£8,000 for a tube shunt, and £2,000–£4,000 for MIGS (often bundled with cataract surgery). Preserflo and XEN sit in between at £3,500–£6,500.
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What is mitomycin-C and why is it used?
MMC is an anti-scarring agent applied under the conjunctiva during trabeculectomy. It stops the bleb scarring closed, doubling the chance of long-term IOP control - but it also raises the lifetime risk of bleb-related infection, which is why bleb surveillance matters.
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What is the recovery like after a trabeculectomy?
Weekly visits for the first month, intensive steroid drops tapering over 2–3 months, no rubbing or swimming for four weeks, and a shield at night for a week. Vision is blurry and fluctuating for 6–12 weeks before it settles.
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How successful is trabeculectomy long-term?
With mitomycin-C, 60–80% of eyes reach target IOP without drops at five years. Tube shunts achieve 50–70% and MIGS 30–50% drop-free. Some patients still need a drop or two afterwards - that is a success, not a failure.
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What are the serious risks I should know about?
The two that matter most are early hypotony (soft eye, flat chamber, maculopathy) and the lifetime risk of bleb-related endophthalmitis with MMC blebs (0.5–2%) - a red, painful, blurred eye at any point after surgery is a same-day emergency, forever. Tubes carry tube exposure and corneal endothelial loss.
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When should I see an eye A&E urgently?
Sudden pain, sudden loss of vision, a red painful eye, discharge from the bleb, or a hazy cornea - at any point in your life after glaucoma surgery - are reasons to attend eye A&E the same day, not wait for clinic.
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