Overview
What Is A Trabeculectomy?
When Treatment With Eye Drops, Pills, Or Laser Surgery Does Not Lower Intraocular Pressure To A Safe Level, Your Ophthalmologist May Determine That Glaucoma Surgery Should Be Performed. One Way To Reduce Pressure In An Eye With Glaucoma Is To Make A New Drain In The Eye. This Type Of Surgery Is Called A Trabeculectomy.During This Operation, A Tiny Piece Of The Wall Of The Eye, Which May Include The Trabecular Meshwork (The Natural Drain), Is Removed By The Surgeon. This Opens A New Drain Which Creates A Bypass For The Trabecular Meshwork To Reduce Eye Pressure. The Eye Pressure Is Reduced Because Fluid Can Now Drain With Relative Ease Through The New Opening Into A Reservoir (Bleb) Underneath The Conjunctiva (Which Comprises The Surface Of The Eye). The Fluid Is Then Absorbed By The Body.
Why It Is Done
Vitrectomy May Be Done To : -
- Repair Or Prevent Traction Retinal Detachment, Especially When It Threatens To Affect The Macula.
- Repair Very Large Tears In The Retina.
- Reduce Vision Loss Caused By Bleeding In The Vitreous Gel (Vitreous Hemorrhage) When Bleeding Is Severe Or When The Blood Does Not Clear On Its Own After Several Months.
- Treat Severe Proliferative Retinopathy That Causes Severe Scar Tissue Formation Or When Growth Of New Blood Vessels On The Retina (Neovascularization) Continues Despite Repeated Laser Treatment.
What To Expect After Surgery ?
The Person Does Not Have To Be Admitted To The Hospital. But Children May Stay In The Hospital Overnight Following Surgery. And In Some Cases, Your Doctor May Recommend That You Stay In The Hospital.
Immediately After Surgery, Antibiotics May Be Applied To The Eye. Also, Antibiotics May Be Injected Under The Lining Of The Eyelid (Conjunctiva). After Surgery, The Eyelid Is Usually Taped Shut, And A Hard Covering (Eye Shield) Is Placed Over The Eye.
The Person Wears A Dressing Over The Eye During The First Night After Surgery And Wears The Eye Shield At Bedtime For Up To A Month. Corticosteroids Are Usually Applied To The Eye For About 1 To 2 Months After Surgery To Decrease Inflammation In The Eye.
People Who Have A Trabeculectomy Without Being Admitted To The Hospital Usually Have A Checkup The Following Day With Their Eye Specialist.
Any Activity That Might Jar The Eye Needs To Be Avoided After Surgery. People Usually Need To Avoid Bending, Lifting, Or Straining For Several Weeks After Surgery.
After Surgery, People Who Have Problems With Constipation May Need To Take Laxatives To Avoid Straining While Trying To Pass Stools. Straining Can Raise The Pressure Inside The Eye, Increasing The Risk Of Damage To The Optic Nerve Or Bleeding.
Usually There Is Mild Discomfort After A Trabeculectomy. Severe Pain May Be A Sign Of Complications. If You Have Severe Pain After A Trabeculectomy, Call Your Doctor Immediately.
Risks
The Most Common Problem After A Trabeculectomy Is Scarring Of The Opening. Scarring Prevents Fluid Drainage From The Eye And Interferes With The Proper Function Of The Bleb. Mitomycin-C Is Commonly Used During Surgery To Prevent Scarring. It Is More Commonly Used Than 5-Fluorouracil, But It Cannot Be Used After Surgery. 5-Fluorouracil Can Be Used During The Surgery Or Injected Into The Thin Tissue (Conjunctiva) Covering The Eye After Surgery To Prevent Scarring.Other Complications Of This Surgery That May Develop Soon After Surgery Include : -
- Severe Blurring Of Vision For Several Weeks (Usual).
- Bleeding In The Eye.
- Extremely Low Pressures In The Eye, Which May Result In Blurred Vision That Results From Clouding Of The Lens (Cataract), Fluid Buildup Under The Nerve Layer In The Eye (Retina).
- Sudden, Permanent Loss Of Central Vision. This Risk Depends In Part On How Much Central Vision Had Been Lost Before Surgery.
- Infection In The Eye.
- High Pressure In The Eye, Causing The Space In The Front Part Of The Eye (Anterior Chamber) To Collapse (Malignant Glaucoma). This Is Rare.
Late Complications After A Trabeculectomy May Include : -
- A Cataract That Is Worse Than It Was Before Surgery (Usual).
- Continued Changes In The Nerve At The Back Of The Eye Related To Glaucoma.
- Infection.
- Droopy Eyelid (A Very Slight Droop Of The Eyelid Is Common).
Diagnosis/Preparation
The Procedure Is Fully Explained And Any Alternative Methods To Control Intraocular Pressure Are Discussed. Antiglaucoma Drugs Are Prescribed Before Surgery. Added Pressure On The Eye Caused From Coughing Or Sneezing Should Be Avoided.Several Eye Drops Are Applied Immediately Before Surgery. The Eye Is Sterilized, And The Patient Draped. A Speculum Is Inserted To Keep The Eyelids Apart During Surgery.
Aftercare
Eye Drops, And Perhaps Patching, Will Be Needed Until The Eye Is Healed. Driving Should Be Restricted Until The Ophthalmologist Grants Permission. The Patient May Experience Blurred Vision. Severe Eye Pain, Light Sensitivity, And Vision Loss Should Be Reported To The Physician.Antibiotic And Anti-Inflammatory Eye Drops Must Be Used For At Least Six Weeks After Surgery. Additional Medicines May Be Prescribed To Reduce Scarring.
Contact Your Doctor Right Away If You Notice Any Signs Of Complications After Surgery, Such As:
- Decreasing Vision.
- Increasing Pain.
- Increasing Redness.
- Swelling Around The Eye.
- Any Discharge From The Eye.
- Any New Floaters, Flashes Of Light, Or Changes In Your Field Of Vision.
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