Trabeculectomy Surgery

Trabeculectomy Surgery for Glaucoma

Trabeculectomy surgery is an incisional procedure for the treatment of eye pressure (intraocular pressure) caused by glaucoma. The goal of the procedure is to relieve intraocular pressure (IOP) and prevent further vision loss caused by damage to the optic nerve.

During the procedure, your surgeon will create a tiny opening where the cornea (the clear part of the eye) meets the sclera (the white of the eye). This opening is then covered by a thin “trap door” (known as a scleral flap) through which small sutures are placed to allow controlled flow of aqueous humor from the eye.

Sometimes, a small shunt known as an Ex-Press Glaucoma Filtration Device is placed under the scleral flap instead of surgically creating a hole. The surgical area is then sealed with conjunctiva (the membrane that covers your eye), and as aqueous humor flows from the eye into the conjunctiva, a structure called a bleb is created. This process reduces IOP and prevents further vision loss.

Trabeculectomy surgery often leads to a decreased reliance on medical treatment for glaucoma.

Who Is a Good Candidate for Trabeculectomy Surgery?

Incisional surgery is typically recommended for those whose glaucoma has not successfully been treated with eye drops or laser treatments. Trabeculectomy is a standard incisional glaucoma procedure typically used to treat open-angle glaucoma and chronic angle-closure glaucoma.

It’s important to note that glaucoma surgery, including trabeculectomy, cannot cure glaucoma or undo vision loss, but it can help lower IOP and prevent further loss of vision. Your surgeon will determine if you are a good candidate for trabeculectomy surgery based on your unique situation.

Leading Up to Your Surgery

Blood tests and an electrocardiogram may be ordered prior to the procedure. Your surgeon will usually recommend that you stop taking blood thinners (especially Coumadin), products containing aspirin, and many arthritis medications usually seven to 10 days before surgery (after receiving approval from your personal physician). If you are pregnant or may become pregnant within six months after surgery, alert your surgeon and staff as some medications used during the procedure may harm an unborn baby.

You may not eat or drink in the six hours leading up to your surgery. You may continue to use your prescribed glaucoma eye drops and take other normal medications (with water only), unless otherwise instructed by your surgeon. Those who have diabetes and/or use insulin will receive special instruction from their surgeon prior to surgery.

During the Procedure

The procedure is typically performed under local anesthesia with careful monitoring from our staff. You will also be sedated in the pre-operative area or in the operating room.

You will be monitored to ensure that you remain medically stable and comfortable. You should not experience much pain, although you may feel some pressure around the eye being treated.

Following the Procedure

You may have a patch placed over the treated eye. When your surgeon deems you are stable in the recovery area, you will be discharged to be driven home by a friend or family member. A follow-up appointment at DMEI will be scheduled for the next morning, at which time your patch will be removed and the eye examined. The stitches placed during the surgery will dissolve on their own.

Your eye pressure may be high or low following the procedure. If it is high, your surgeon may perform a painless laser treatment to adjust the tightness of the scleral flap and increase the outflow of fluid.

The fluid that is released from the inside of the eye will collect beneath the conjunctiva. This forms a filtering bleb, which may appear as an elevation or whitening of tissue near the surgical site. This elevated bleb may have a “bubble-like” appearance and can affect the flow of the tear film across the eye. If this should cause any discomfort, lubricating drops or ointments may be used temporarily.

Your glaucoma eye drops should be discontinued. However, you will be given some medication to reduce inflammation and the chance of infection. These will be tapered over the next several weeks to months as the inflammation subsides.

To protect your eye after surgery, you should wear your glasses or sunglasses during the day and a plastic shield at night. Your doctor will also give you instructions regarding activity restrictions. In general, you should avoid heavy lifting, strenuous activity, bending or stooping below the waist, or hard nose blowing during the first few weeks following surgery or until the eye pressure stabilizes.

It is not possible to wear soft contact lenses after trabeculectomy since the filtering bleb prevents the lens from fitting properly. You may be able to wear a hard contact lens. However, this generally requires a refit after surgery to make sure that it does not irritate the surgical site.

Are There Risks Associated with Trabeculectomy Surgery?

Possible, but rare, complications can include severe bleeding either during or after the surgery, severe infection, or permanent worsening or loss of vision. You may also experience drooping of the eyelid, decreased vision from progression of a pre-existing cataract or swelling in the back of the eye, or scarring at the surgical site with a rise in eye pressure. Eye pressure can remain very low following surgery, which can affect vision.

Even long after your trabeculectomy, you should wear high-quality, protective goggles when swimming or engaging in water sports to decrease the risk of infection. If you should develop “pink eye” (conjunctivitis) even many years after surgery, it can be very serious if not properly treated. Should this happen, contact your ophthalmologist as soon as possible.

Recovery Time

It is typical for your vision to be initially blurred after surgery. Depending on how your eye responds to the surgery, it may take a few or several weeks for you to recover full vision.