Understanding the Gel Stent Procedure
A gel stent is a tiny, soft tube used in minimally invasive glaucoma surgery, often called MIGS. The stent is made from a gelatin material that is safe for use inside the eye. It is about the size of an eyelash. Your surgeon places it inside the eye to create a new pathway for fluid to drain. This helps lower eye pressure, which is the main goal of glaucoma treatment.
Glaucoma is a group of eye diseases that damage the optic nerve. The optic nerve is the cable that sends visual signals from your eye to your brain. When pressure inside the eye stays too high for too long, it can harm this nerve and lead to vision loss. More than 3 million Americans have glaucoma, but only half are aware of their condition (Glaucoma Research Foundation, 2023). Early treatment is key to protecting your sight.
There are several types of MIGS devices available today. Many of them work by helping fluid drain into a tiny channel inside the eye called Schlemm's canal. The gel stent takes a different approach. Instead of draining into Schlemm's canal, it creates a new drainage path under the conjunctiva. The conjunctiva is the thin, clear tissue that covers the white part of your eye.
By sending fluid to a space beneath the conjunctiva, the gel stent creates what doctors call a filtering bleb. A bleb is a small, raised pocket of fluid on the surface of the eye, usually hidden under the upper eyelid. This bleb acts as a reservoir where fluid collects before the body absorbs it naturally. This approach can sometimes achieve lower eye pressure than devices that drain into Schlemm's canal alone.
Your eye constantly produces a clear fluid called aqueous humor. This fluid nourishes the front of the eye and keeps it healthy. Normally, the fluid drains out at the same rate it is produced. In glaucoma, the drainage system does not work well enough. Fluid builds up and eye pressure rises. Over time, this increased pressure can damage the optic nerve. The gel stent gives fluid a new way to leave the eye, helping to bring pressure down to a safer level.
Best Uses for the Gel Stent
Open-angle glaucoma is the most common form of this disease. Open-angle glaucoma accounts for 90% of all glaucoma cases in the United States (National Eye Institute, 2023). In this type, the eye's natural drainage angle stays open, but the tiny channels within it become clogged over time. The gel stent is most often used for people with mild to moderate open-angle glaucoma. In some cases, doctors may also consider it for more advanced disease when other options are limited.
Many people with glaucoma use one or more prescription eye drops every day to control their pressure. These drops can cause side effects such as redness, stinging, dry eyes, or changes in eye color. Some people find it hard to remember their drops or to put them in correctly. The gel stent can help reduce the number of drops you need. Some patients are able to stop using drops altogether after surgery, though this is not the case for everyone.
If you have both glaucoma and a cataract, your surgeon may be able to place the gel stent during your cataract operation. Combining the two procedures means you only need one trip to the operating room and one recovery period. This can be more convenient and may improve your results for both conditions at the same time.
For some patients, eye drops and laser procedures do not lower pressure enough to protect the optic nerve. The gel stent offers a next step that is less invasive than traditional glaucoma surgeries such as trabeculectomy or tube shunt placement. It may serve as a bridge between less invasive treatments and more involved surgical options.
Who Is a Good Candidate
The gel stent works well for people whose glaucoma has not reached a very advanced stage. If your eye pressure is not controlled with drops alone, or if you are using multiple medications with bothersome side effects, you may be a good candidate. Your doctor will look at your overall eye health, the health of your optic nerve, and your visual field test results to help decide.
Keeping up with a daily eye drop routine can be challenging. Physical conditions such as arthritis can make it hard to squeeze the bottle. Busy schedules, travel, or simply forgetting a dose can lead to gaps in treatment. If you have difficulty sticking to your drop regimen, the gel stent may offer a way to lower your pressure without relying as heavily on drops.
Traditional glaucoma surgeries like trabeculectomy involve creating a flap in the wall of the eye. These procedures can be very effective but come with a longer recovery time and a higher chance of complications. The gel stent procedure is shorter, uses a smaller incision, and typically allows for a faster recovery. This makes it appealing for patients who want surgical treatment without the demands of a larger operation.
The gel stent is not right for everyone. It may not be the best choice for people with certain types of glaucoma, such as angle-closure glaucoma or neovascular glaucoma. Patients with significant scarring on the conjunctiva from previous eye surgeries may also face challenges. Your glaucoma specialist at Washington Eye Institute will evaluate your specific situation and help determine the most suitable treatment path.
How the Gel Stent Works
The gel stent is a small, flexible tube made from a material derived from gelatin. It is very thin and measures only a few millimeters in length. Because it is soft and pliable, it conforms to the natural shape of the eye. The material is well tolerated by the body and has been used safely in other medical applications for many years.
During the procedure, your surgeon uses a special injector to place the gel stent through the wall of the eye. One end of the stent sits inside the anterior chamber, which is the front compartment of the eye filled with aqueous humor. The other end extends into the subconjunctival space, the area just beneath the conjunctiva on the outside of the eye. Fluid flows from inside the eye, through the tiny tube, and into this space. The body then absorbs the fluid naturally over time.
As fluid drains through the stent, it collects under the conjunctiva and forms a bleb. The bleb is typically located under the upper eyelid, so it is not visible to others. A healthy, well-functioning bleb is a sign that the stent is working properly. Your doctor will monitor the bleb at your follow-up visits to make sure fluid is draining as expected.
One of the main challenges with any procedure that creates a bleb is scarring. The body naturally tries to heal the area where fluid collects, which can close off the drainage pathway over time. To reduce this risk, your surgeon may apply a medication called mitomycin C during or after the procedure. Mitomycin C is an anti-scarring agent that helps keep the bleb open and functioning. This medication has been used in glaucoma surgery for decades and plays an important role in long-term success.
Types and Options for Gel Stent Surgery
In a standalone procedure, the gel stent is placed on its own without any additional surgery at the same time. This option is often chosen when the patient does not have a cataract or when the cataract does not yet need to be removed. The operation is performed in an outpatient surgery center. It typically takes fifteen to twenty minutes. You go home the same day.
When a patient needs both glaucoma treatment and cataract removal, the two procedures can be performed together. The cataract surgery is done first, and then the gel stent is placed through the same small incision or a separate tiny opening. Combining the procedures can save time and reduce the overall recovery period. Many patients find this approach convenient because it addresses two problems during one visit to the operating room.
In some cases, the bleb may become blocked by scar tissue after the initial surgery. When this happens, a simple office procedure called needling can be performed. During needling, the doctor uses a small needle to gently break up the scar tissue and reopen the drainage pathway. This is a minor procedure that can often restore the function of the stent without the need for another trip to the operating room. Not every patient needs a needling revision, but it is a common and well-established technique.
The world of MIGS includes several different devices and approaches. Some devices work inside the eye at Schlemm's canal. Others use tiny tubes or stents placed in different locations. The gel stent is unique because it creates subconjunctival drainage, which can sometimes achieve lower pressures than canal-based devices. Your doctor will discuss the full range of options with you and recommend the approach that best fits your type and stage of glaucoma.
What to Expect
Your journey begins with a thorough eye examination. Your doctor will measure your eye pressure, examine the drainage angle using a special lens, check your optic nerve, and review your visual field tests. You will also discuss your current medications and overall health history. If you take blood thinners, your doctor will give you specific instructions about whether to pause them before surgery.
In the days leading up to the procedure, you may be asked to start using antibiotic eye drops to reduce the risk of infection. Your doctor's office will provide detailed instructions about eating, drinking, and transportation on the day of surgery. You will need someone to drive you home afterward.
The gel stent procedure is performed in an outpatient surgical setting. You will be awake during the operation, but your eye will be numbed with local anesthesia so you do not feel pain. You may also receive a mild sedative to help you relax. The surgeon views the inside of your eye through a special microscope.
Using a small, pre-loaded injector, the surgeon inserts the gel stent through a tiny incision in the cornea. The stent is guided into position so that one end sits in the anterior chamber and the other end rests beneath the conjunctiva. The entire process typically takes fifteen to twenty minutes. You should not feel the stent inside your eye after surgery.
You will rest briefly in the recovery area while the care team monitors you. Your eye may be covered with a protective shield. It is normal for your vision to be slightly blurry on the first day. You may notice mild discomfort, a gritty feeling, or some redness. These sensations usually improve within the first few days.
Your doctor will prescribe eye drops to use during recovery. These typically include:
- Antibiotic drops to prevent infection
- Anti-inflammatory drops to reduce swelling
- Steroid drops that are gradually tapered over several weeks
During the first week, it is important to protect your eye and allow it to heal. Your care team will provide specific guidelines. General recommendations include:
- Avoid rubbing or pressing on your eye
- Do not bend over or lift heavy objects
- Keep water and soap out of your eye while showering
- Wear your eye shield while sleeping for the first week
- Avoid swimming, hot tubs, and dusty environments
You will have a follow-up appointment within the first day or two after surgery. Your doctor will check your eye pressure, examine the bleb, and make sure everything is healing properly.
Most patients notice gradual improvement during this period. Your eye may still be somewhat red or feel slightly irritated, but these symptoms should continue to fade. You will have several follow-up visits during this time so your doctor can monitor your pressure and the health of the bleb.
Your steroid and anti-inflammatory drops will be slowly reduced according to a schedule your doctor provides. It is important to follow this schedule closely. Stopping these drops too early can increase the risk of scarring around the bleb. During this phase, your doctor will also evaluate whether any changes to your glaucoma medications are needed.
Full healing after gel stent surgery can take several months. Your eye pressure may fluctuate during the first few weeks as the bleb matures and your eye adjusts. It is common for the pressure to be quite low in the early days and then settle into a more stable range over time.
Many patients achieve a meaningful reduction in eye pressure and are able to reduce the number of glaucoma medications they use. Some patients are able to discontinue drops entirely. Your individual results will depend on many factors, including the severity of your glaucoma, your eye's healing response, and how well the bleb functions over time. Regular follow-up visits are essential to ensure the stent continues to work effectively.
Your Journey at Washington Eye Institute
Your first visit at Washington Eye Institute is a comprehensive evaluation. Our glaucoma specialists will take the time to understand your full eye health history. You will undergo a series of tests, including eye pressure measurements, visual field testing, optical coherence tomography (a scan that creates detailed images of your optic nerve), and gonioscopy (an examination of your eye's drainage angle using a special contact lens).
After reviewing all of your test results, your doctor will sit down with you and discuss your options. If the gel stent is a good fit, they will explain the procedure in detail, answer your questions, and help you feel prepared for what comes next.
Our surgical coordinator will guide you through every step of preparation. You will receive clear instructions about which medications to continue and which to pause. You will know exactly when to arrive, what to wear, and what to bring. We recommend wearing comfortable clothing and leaving jewelry at home. A family member or friend will need to accompany you since you cannot drive yourself home.
On the day of your procedure, you will be greeted by our care team and taken to the preoperative area. A nurse will check your vital signs and place numbing drops in your eye. You may receive a mild sedative through an IV line if your surgeon recommends it. The atmosphere is calm and supportive. Our team is experienced in helping patients feel at ease.
After the procedure, you will rest in our recovery area while we make sure you are comfortable. Before you leave, your doctor will review your postoperative instructions and schedule your first follow-up appointment. The entire visit, from arrival to departure, typically takes two to three hours.
Follow-up care is one of the most important parts of your journey. You will have frequent visits in the first few weeks after surgery, with appointments becoming less frequent as your eye heals. At each visit, your doctor will measure your eye pressure, examine the bleb, and assess how well the stent is functioning.
If the bleb shows signs of scarring, your doctor may recommend a needling procedure or an adjustment to your drop regimen. Our team is proactive about identifying and addressing any issues early. Over the long term, you will continue to see your glaucoma specialist regularly to monitor your eye health and protect your vision.
We understand that eye surgery can feel overwhelming. Our team at Washington Eye Institute is here for you at every stage. You will have a direct line to our office for any questions or concerns that come up between visits. We encourage you to reach out if you experience anything unexpected, such as a sudden increase in pain, a significant change in vision, or unusual redness. Early communication helps us address any issues quickly.
Questions and Answers About the Gel Stent
Like any surgical procedure, the gel stent carries some risks. Possible complications include low eye pressure in the early recovery period, bleeding inside the eye, infection, inflammation, and scarring of the bleb. Serious complications are uncommon. Your surgeon will discuss the specific risks and benefits with you before the procedure. Most patients tolerate the surgery well and experience a smooth recovery. Your doctor at Washington Eye Institute will carefully evaluate your individual risk factors to determine if this procedure is appropriate for you.
Many people can return to light daily activities within a few days of surgery. Driving is usually possible within one to two weeks, depending on how quickly your vision clears. More strenuous activities, such as heavy lifting or vigorous exercise, should be avoided for several weeks. Full healing of the bleb can take two to three months. Your doctor will give you personalized guidance based on how your eye is healing at each follow-up visit.
One of the primary goals of gel stent surgery is to lower eye pressure enough that you can use fewer glaucoma medications. Many patients are able to reduce their drop regimen after the procedure. Some patients reach their target pressure without any drops at all. However, results vary from person to person. Your doctor will work with you over the weeks and months following surgery to find the right combination of treatment for your eyes. It is important not to stop any medications on your own without your doctor's guidance.
If you have a cataract that is affecting your vision, your surgeon may recommend combining cataract removal with gel stent placement. This approach allows you to address both conditions during a single operation and a single recovery period. The combined procedure is performed routinely and does not significantly increase the time you spend in the operating room. Your doctor will help you decide whether a combined approach or a standalone procedure is the better choice for your situation.
The gel stent is extremely small and is placed in a location where it does not come into contact with sensitive parts of the eye. Once the initial healing period is over, you should not feel the stent at all. It does not affect your ability to blink, move your eye, or wear glasses or contact lenses. The stent is designed to remain in place and function for the long term without causing discomfort.
Glaucoma is a condition that requires ongoing monitoring throughout your life. Even after a successful gel stent procedure, you will need regular check-ups to make sure your eye pressure remains at a safe level and that the bleb is functioning properly. These visits also allow your doctor to catch any changes early and adjust your treatment plan if needed. At Washington Eye Institute, our team is committed to providing consistent, thorough follow-up care to help you maintain your vision for years to come.