Goniotomy for glaucoma in San Antonio
A minimally invasive way to lower eye pressure, with or without cataract surgery
Goniotomy is a minimally invasive glaucoma surgery (MIGS) that lowers eye pressure by opening the eye’s clogged drainage system. It’s done through a tiny incision, without a drainage bleb or a permanent implant, and it recovers faster than traditional glaucoma surgery. At San Antonio Eye & Face Institute, Dr. Relief Jones, III, a glaucoma fellowship-trained ophthalmologist, performs goniotomy using the SION blade, both together with cataract surgery and as a standalone procedure.
Reviewed by Dr. Relief Jones, III, M.D. · Last updated: October 9, 2026
At a glance
| What it is | Minimally invasive glaucoma surgery (MIGS) that removes a strip of the trabecular meshwork to improve drainage |
| Best for | Mild to moderate open-angle glaucoma and ocular hypertension, with an open drainage angle |
| With cataract surgery? | Yes, in the same operation |
| Standalone? | Yes, for example after cataract surgery has already been done |
| Instrument | The SION blade |
| Surgeon | Dr. Relief Jones, III, M.D. (clinical glaucoma fellowship, Massachusetts Eye and Ear/Harvard Medical School) |
| Where | American Surgery Center of South Texas, 12838 Vista Del Norte, San Antonio |
| Implant or bleb? | No permanent implant and no drainage bleb |
| Insurance | Generally covered when medically necessary See insurance we accept |
What is goniotomy?
Fluid called aqueous humor is constantly made inside the eye and drains out through a spongy tissue called the trabecular meshwork, located in the drainage angle where the iris meets the cornea. In many people with open-angle glaucoma, this meshwork becomes resistant and fluid can’t leave the eye easily, so the pressure rises and can damage the optic nerve.
In goniotomy, the surgeon looks directly at the drainage angle using a special magnifying lens (gonioscopy) and removes a strip of the trabecular meshwork with a tiny blade. This opens a path for fluid to reach the eye’s natural drainage channels, which lowers eye pressure. It’s performed from inside the eye through a very small incision, called an ab interno approach. Unlike traditional glaucoma surgery, it doesn’t create a drainage bleb, and, unlike stents, it doesn’t leave a device in the eye.
Learn more about glaucoma
Goniotomy with cataract surgery
Many patients with glaucoma also have cataracts. Combining the two lets you treat both in one operation, with one recovery. Cataract surgery alone lowers eye pressure slightly in many eyes, and adding goniotomy can lower it further and may reduce the number of drops you need. Dr. Jones removes the cataract, places your new lens, and then performs the goniotomy during the same procedure. Glaucoma can influence which lens is best for you, so we’ll discuss your options together.
Cataract surgery · Premium lens options
Standalone goniotomy
Goniotomy can also be done by itself, for example if you’ve already had cataract surgery (you have a lens implant) and your pressure needs to come down, or if drops or SLT haven’t worked well enough. It can also be an option when you want to rely less on drops. Dr. Jones will tell you honestly if a different treatment is a better fit.
The SION blade
Dr. Jones’s preferred instrument for goniotomy is the SION blade, a precision surgical instrument that’s passed through a small corneal incision to open the trabecular meshwork while viewing the drainage angle under magnification. Dr. Jones states that this device is both smooth and precise, which makes the procedure similarly reproducible from one case to the next.
Who is a good candidate?
You may be a candidate if you have:
- Mild to moderate open-angle glaucoma, including primary, pigmentary, and pseudoexfoliation types, or ocular hypertension
- An open drainage angle on your exam (gonioscopy)
- A cataract and want to address your glaucoma at the same time
- A wish to rely less on glaucoma drops, or drops that aren’t controlling your pressure enough or cause side effects
Goniotomy may not be the best choice if you have:
- Advanced glaucoma that needs a very low target pressure (traditional surgery may be more effective)
- Closed or scarred drainage angles, or narrow angles that haven’t been opened
- Neovascular glaucoma or certain other secondary glaucomas
- Conditions that raise eye pressure outside of the drainage meshwork
- An angle that can’t be seen clearly
Your exam, including gonioscopy, shows which procedure is right for you.
How well does it work?
Goniotomy can meaningfully lower eye pressure and reduce the number of glaucoma drops many patients need, especially when combined with cataract surgery. Results vary from person to person, and it doesn’t work for everyone. Goniotomy generally lowers pressure less than trabeculectomy or tube shunt surgery, which is why it’s best suited to mild and moderate glaucoma. It doesn’t cure glaucoma or repair damage already done to the optic nerve, so you’ll still need regular check-ups.
How does it compare with other glaucoma treatments?
| Treatment | How it works | Invasiveness | Typical use |
|---|---|---|---|
| SLT (laser) | Helps the meshwork drain better | Least invasive; in-office | Open-angle glaucoma; first-line or add-on |
| Goniotomy | Removes a strip of meshwork | Minimally invasive; no implant, no bleb | Mild to moderate open-angle glaucoma, often with cataract surgery |
| Stents (iStent, Hydrus) | Implant placed in the drainage system | Minimally invasive; leaves a device | Mild to moderate glaucoma, usually with cataract surgery |
| Trabeculectomy / tube shunts | Create a new drainage path | More invasive; more follow-up and risk | Moderate to advanced glaucoma needing lower pressure |
| MP-CPC (laser) | Reduces fluid production | In the operating room; no incision | Advanced or hard-to-treat glaucoma |
SLT and MP-CPC laser treatment
What to expect
Before. We examine your eyes and optic nerve, check your drainage angle with gonioscopy, and may repeat tests such as OCT and visual fields. We discuss whether goniotomy, alone or with cataract surgery, is right for you, and what to do about your drops before surgery.
Surgery day. Goniotomy is an outpatient procedure at the American Surgery Center. You receive IV sedation and your eye is numbed, so you’re relaxed and comfortable. Dr. Jones passes the SION blade through a small incision, views your drainage angle with a special lens, and removes a strip of the trabecular meshwork. When it’s combined with cataract surgery, it’s performed in the same operation. It add approximately 10 minutes to the surgery time. You go home the same day with a friend or family member.
After. You’ll use drops, typically an antibiotic and an anti-inflammatory, as directed, and keep taking your glaucoma drops unless we tell you otherwise. You may have blurry vision, light sensitivity, or a little blood in the front of the eye (hyphema) for a few days to weeks, which usually clears on its own. Avoid rubbing your eye and follow your activity instructions. We’ll see you the day after surgery and again at follow-up visits to check your pressure and healing.
Risks
Goniotomy generally has lower risks than traditional glaucoma surgery, but, as with any surgery, there are risks, and it isn’t possible to list every possible complication. They include:
- Bleeding in the front of the eye (hyphema), the most common effect
- A temporary rise in eye pressure
- Inflammation and blurry vision
- Scarring that reduces the effect over time
- The need for additional treatment or surgery
- Rarely, infection, very low eye pressure, or vision loss
We take precautions to avoid problems, and if one occurs, we take steps to manage it. No specific outcome can be guaranteed.
Cost and insurance
Medicare and most insurance plans generally cover minimally invasive glaucoma surgery when it’s medically necessary, including when it’s performed with cataract surgery. Coverage varies by plan, so call us and we’ll check your benefits so there are no surprises.
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Why choose San Antonio Eye & Face Institute
- A glaucoma fellowship-trained surgeon. Dr. Jones completed a clinical glaucoma fellowship at Massachusetts Eye and Ear/Harvard Medical School, and performs goniotomy both with cataract surgery and as a standalone procedure.
Read Dr. Jones’s bio - One team for glaucoma and cataracts, so your care is coordinated.
- The full range of options, from drops and lasers (SLT, MP-CPC) to MIGS and traditional surgery, so we recommend what fits your eyes, not just one procedure.
- Physician-owned, so you see your doctors from your first exam to your last follow-up.
- Se habla español.
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Frequently asked questions
What is goniotomy? Goniotomy is a minimally invasive glaucoma surgery (MIGS) that lowers eye pressure by removing a strip of the trabecular meshwork, the clogged part of the eye’s drainage system, so fluid can drain more freely. It is done through a tiny incision, and no drainage bleb or permanent implant is needed.
How does goniotomy lower eye pressure? In many people with open-angle glaucoma, the trabecular meshwork resists the flow of fluid out of the eye. By opening the meshwork, goniotomy lets fluid reach the eye’s natural drainage channels more easily, which lowers eye pressure.
Can goniotomy be done with cataract surgery? Yes. Dr. Jones performs goniotomy during cataract surgery, so you can treat your cataract and lower your eye pressure in one operation.
Can goniotomy be done by itself? Yes. Dr. Jones also performs goniotomy as a standalone procedure, for example for patients who have already had cataract surgery and need lower eye pressure.
What is the SION blade? The SION blade is a precision surgical instrument used to perform goniotomy. Dr. Jones uses it to open the trabecular meshwork while viewing the drainage angle under magnification.
Who is a good candidate for goniotomy? Goniotomy is used for mild to moderate open-angle glaucoma, including primary, pigmentary, and pseudoexfoliation types, and for ocular hypertension, in eyes where the drainage angle is open. It is often a good fit for patients who also need cataract surgery or who want to rely less on glaucoma drops.
Who is not a good candidate for goniotomy? Patients with advanced glaucoma that needs a very low pressure, closed or scarred drainage angles, neovascular glaucoma, or conditions that raise the pressure outside the eye’s drainage meshwork may need a different treatment. Your exam, including gonioscopy, shows which procedure is right for you.
How well does goniotomy work? Results vary. Studies show that goniotomy can meaningfully lower eye pressure and reduce the number of glaucoma drops patients need, especially when combined with cataract surgery. It usually lowers pressure less than trabeculectomy or tube shunt surgery, which is why it is best suited to mild to moderate glaucoma.
Will I still need glaucoma drops after goniotomy? Many patients need fewer drops, and some can stop them, but goniotomy does not work for everyone. Your doctor will tell you if and when to reduce your drops, so do not stop any on your own.
What are the risks of goniotomy? Possible risks include bleeding in the front of the eye (hyphema), a temporary rise in eye pressure, inflammation, blurry vision, scarring that reduces the effect, and the need for additional treatment. Rarely, infection, very low pressure, or vision loss can occur. Goniotomy generally has lower risks than traditional glaucoma surgery.
How long is recovery after goniotomy? Recovery is generally quick, with less downtime than traditional glaucoma surgery. You may have mild blurry vision, light sensitivity, or some blood in the front of the eye for a few days to weeks. You will use drops as directed and have follow-up visits to check your eye pressure.
How is goniotomy different from stents such as iStent or Hydrus? Stents such as iStent and Hydrus are implants placed in the eye’s drainage system, while goniotomy removes a strip of the trabecular meshwork without leaving a device in the eye. Your doctor will recommend the option that best fits your type of glaucoma and your goals.
Is goniotomy covered by insurance? Medicare and most insurance plans generally cover minimally invasive glaucoma surgery when it is medically necessary, including when it is performed with cataract surgery. Coverage varies by plan, so call our office and we will check your benefits.
Is this the same goniotomy used for babies with congenital glaucoma? The term goniotomy has long been used for a surgery that treats congenital glaucoma in infants. The procedure described on this page is a minimally invasive adult version performed from inside the eye with a different instrument.
Who performs goniotomy at your practice? Dr. Relief Jones, III, a glaucoma fellowship-trained ophthalmologist, performs goniotomy at the American Surgery Center, both with cataract surgery and as a standalone procedure.
This page is for general education and isn’t a substitute for an eye exam. Only an eye doctor can tell you whether goniotomy is right for you.
Watch: goniotomy video