What is Trabeculectomy?
A trabeculectomy is a surgical treatment for glaucoma. It aims to lower intraocular pressure (IOP) by creating a new pathway for fluid drainage.
Glaucoma is an eye disease that occurs when the fluid inside the eye (aqueous humor) doesn’t drain normally. Over time, the fluid builds up and increases IOP inside the eye, damaging the optic nerve.
Uncontrolled glaucoma leads to a loss of peripheral vision and possibly central vision. Without treatment, this condition can cause complete blindness.
The goal of trabeculectomy is to reduce or prevent vision loss. However, this surgery cannot restore vision.
Who Needs a Trabeculectomy?
Trabeculectomy is a common treatment option for several types of glaucoma, including:
- Closed-angle glaucoma
- Open-angle glaucoma
- Primary glaucoma
- Secondary glaucoma
Your doctor may recommend a trabeculectomy if other treatments, such as glaucoma medications or laser surgery, cannot lower your IOP.
What are the Success Rates of Trabeculectomy?
Trabeculectomy surgery is an effective procedure for reducing intraocular pressure (IOP) and treating glaucoma. Its long-term success rate is close to 90%.
Most people stop taking glaucoma medications because their eye pressure stays controlled after surgery. Overall, the outcome of trabeculectomy is good with follow-up appointments and close monitoring by an eye doctor.
What are the Risks of a Trabeculectomy?
Trabeculectomy surgery is considered safe and effective. However, there’s some risk of complications, such as:
- Failure to control eye pressure. Scar tissue around the surgical site can prevent fluid flow from inside the eye. Your surgeon may recommend a revision or a different surgery to lower eye pressure.
- Blurry vision. Excessive fluid drainage can cause pressure to drop too far, resulting in blurry vision. This may be temporary or require additional surgery.
- Bleb leaks. May occur right after surgery or months after the eye heals. They can resolve on their own, but you may need another surgery to stop the leak.
- Bleeding in the eye. Can result from surgery itself or low eye pressure. Fortunately, eye bleeding rarely causes vision loss.
- Eye infections. An infection may develop at the surgery site. Without immediate treatment, the infection can enter the eye and cause vision loss.
- Cataracts. Trabeculectomy can speed up the development of cataracts. Cataract surgery is a common and highly effective way to treat this.
What to Expect from a Trabeculectomy Procedure
Trabeculectomy is typically an outpatient procedure, meaning you can go home the same day. The surgical procedure usually takes about an hour.
You may be awake during it, so they’ll give you medications to relax and an anesthetic to numb the eye. You may also receive general anesthesia, allowing you to sleep through the surgery.
During the procedure, your surgeon will clean your eye and hold it open with a speculum. This helps them create a flap in the white part of your eye (sclera) beneath the upper eyelid. The flap is used as a new channel for fluid to drain out of your eye.
The scleral flap is then sutured back in place with fine sutures, which are placed in a way that allows controlled drainage of the aqueous humor. Afterward, steroid and antibiotic injections are often administered to reduce inflammation and prevent infection.
How To Prepare for Surgery
If the trabeculectomy occurs in an outpatient clinic, ensure you have a designated driver to take you home. Remove makeup, leave your contact lenses at home, and wear comfortable clothing and shoes.
Your eye doctor will give you instructions to help prepare for surgery. If you don’t follow the instructions closely, your doctor might cancel the surgery for safety reasons.
Before you go into surgery, feel free to talk to your surgeon about your concerns. You can ask them if you need to stop taking medications or fast before the procedure.
What To Do After Surgery?
Recovery from a trabeculectomy can take 4 to 6 weeks and may cause some soreness or redness around the eye. You can also expect blurred vision up to 6 weeks after the procedure.
During your recovery, you should:
- Avoid lifting, bending, and vigorous exercise
- Avoid swimming, gardening, and dusting for at least 2 weeks
- Wear an eye shield at night to prevent accidental eye injury
- Avoid wearing makeup and contact lenses
- Frequently visit your doctor to monitor eye drainage
Your doctor will prescribe steroid eye drops and other medications to prevent infection, reduce inflammation, and minimize bleb scarring. You should use these as directed by your doctor.
Overall, trabeculectomy is an effective and safe procedure for correcting glaucoma. However, it’s important to be aware of the risks. Talk to your doctor about trabeculectomy to see if the procedure is right for you.
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