Trabeculectomy

What is a trabeculectomy?

Trabeculectomy is a surgical procedure used to lower eye pressure in people with glaucoma. Glaucoma is an eye disease in which the optic nerve is damaged because of high pressure inside the eye. When a trabeculectomy is done, the surgeon creates a microscopic passageway from the inside to the outside of your eye. This helps fluid drain better from your eye. It can lower the pressure in your eye and may help prevent more damage to the optic nerve and loss of vision. Although lowering the eye pressure can stop more damage, no treatment can restore damage that is already done.

When is it used?

Trabeculectomy (also called filtering surgery) may be used when:

• Medicines do not lower your eye pressure enough.
• You are having harmful side effects from medicines you are taking for the pressure in your eyes or cannot successfully use the medicines your doctor prescribes.
• Laser surgery to lower the eye pressure has not worked or is not possible.

How do I prepare for the procedure?

Arrange for someone to take you home after your surgery.

Follow your healthcare provider's instructions about not smoking before and after the procedure. Smokers heal more slowly after surgery. They are also more likely to have breathing problems during surgery. For this reason, if you are a smoker, you should quit at least 2 weeks before the procedure. It is best to quit 6 to 8 weeks before surgery. Also, your body will heal much better if you do not smoke after the surgery.

If you are taking daily aspirin or other blood thinners for a medical condition, ask your provider if you need to stop taking the medicine before your surgery. If you need a minor pain reliever in the week before surgery, choose acetaminophen rather than aspirin, ibuprofen, or naproxen. This helps avoid extra bleeding during surgery.

The day of the surgery, you should not eat or drink anything before the procedure. If you regularly take any important medicines, your provider may ask you to take them on the day of surgery with a sip of water.

What happens during the procedure?

The procedure is done in an operating room. You will be given a sedative to help you relax. Your eye will be numbed with eyedrops or a shot of a local anesthetic so you will not feel pain during the surgery. General anesthesia is necessary for some people.

After you have been given the anesthetic, your doctor will move back the transparent tissue (the conjunctiva) over the white part of the eye (sclera). Then your doctor will carve a small channel so that fluid can flow more easily from inside the eye to outside the eye. Your doctor may put some medicine on the eye to reduce scarring and keep the new channel from closing. Some doctors may inject medicines into the white part of the eye to decrease the scarring, which can prevent the surgery from being effective.

The surgery does not leave an open hole in your eye. The white of your eye is covered by the conjunctiva. The fluid flows through the new opening, under the conjunctiva, and drains from the eye.

What happens after the procedure?

You will need to be examined the next day. Your doctor may want to check your eyes once or twice a week for 4 to 6 weeks after your surgery.

You will use various eye medicines after surgery to help healing and to reduce the risk of infection.

Your vision may be blurred for several weeks after surgery. As your eye heals, your vision should improve and your eye pressure should be lower. You may need medicine after the surgery to help maintain normal eye pressure. Once your eye heals, you may need to get a new eyeglass prescription.

Your doctor may remove stitches that were placed during the surgery to open up the drainage channel more. This can be done at the office by pulling a stitch, or by cutting it with a laser.

In general, you will not be able to wear contact lenses after this type of surgery. If you are a contact lens wearer, talk to your eye doctor about your options.

What are the risks?

All surgery carries some risks. After surgery you may:

• Develop a cataract (cloudy lens in the eye), which happens to about one-third of people in 5 years.
• Have scarring around the new drain.
• Have bleeding in your eye. Bleeding a lot is very rare. A little blood in your eye is common and usually does not need treatment.
• Develop an infection. This can happen long after the surgery. You should call your doctor right away if you have pain, redness, or drainage in the eye that was treated.
• Have too much drainage. This is usually controlled with minor treatment such as patching the eye shut for a day or two. However, sometimes further surgery is needed.