As with other treatments for the body, we strive to minimize the invasiveness of surgical intervention for glaucoma management. Over the past decade, we have been fortunate in that a number of micro-invasive glaucoma procedures (or MIGS) have become available to reduce the eye’s pressure with a much lower degree of recovery and risk compared to older traditional glaucoma surgeries. The aim of MIGS is to enhance the eye’s natural outflow by manipulating various levels of the natural drainage system. Some MIGS procedures can only be performed in conjunction with cataract surgery, while others can be done before, after, or during cataract surgery. The eye and its drainage system are carefully examined in the clinic and the best procedure will be chosen to maximize results. Unfortunately, glaucoma surgery does not always work and some patients do require more than one procedure—regardless if one has a MIGS or traditional filtration procedure. Though MIGS procedures have a proven track record of success, there are times a procedure is performed that fails to yield the desired result of reducing one’s eye pressure. This is primarily due to advanced closure or disease of the drainage system that is unable to be rejuvenated with the surgical procedure. The best analogy is to think of patients that have heart disease and have stents placed in the heart’s arteries. Because arteries can be so clogged, stents sometimes fail to open the artery and a bypass procedure is needed. With traditional glaucoma filtration surgery, we bypass the eye’s natural drainage system and create a communication between the high-pressure cavity into a space between the white of the eye and the overlying skin called the conjunctiva. The eye views this passage as a traumatic wound and has a natural tendency to try to seal this wound off with scar tissue. Should the eye succeed in sealing off this passage, fluid will stop filtering and the eye’s pressure will again rise to pre-operative levels. As there is no cure for glaucoma and glaucoma treatment that may fail over time, it is imperative that all patients continue to be monitored lifelong even if surgery has been performed.