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Glaucoma Surgery
Trabeculectomy
'Trabeculectomy is the most commonly performed operation for glaucoma. Lowering of pressure inside the eye is achieved by making a small hole in the eye underneath a thin trap-door of sclera (white of the eye).
Draining the aqueous humour reduces the pressure on the optic nerve, preventing or delaying further loss of vision.
It is important to note that control of the eye pressure with a trabeculectomy operation will not restore vision already lost from glaucoma.
- What does the surgery involve?
- How will my eye appear after surgery?
- What happens after surgery?
- How will I feel after surgery?
The operation typically takes 30 – 45 minutes and may be performed under either local or general anaesthesia, depending on the complexity of the case and other factors.
Adjunctive Mitomycin C is nearly always also used to prevent excessive healing after surgery, thereby increasing the likelihood of a successful outcome.
Mitomycin C is a liquid agent that is applied to the surface of the eye for a brief period of time (typically up to 3 minutes) in order to reduce scarring. At the end of the application, it is washed away from the eye so that no residual drug remains at the end of the operation.
Initially after surgery, the eye will be red, and the upper lid may be swollen and a little droopy. This will return to normal slowly over a period of weeks to months.
The drainage bleb is not usually visible to the naked eye after the trabeculectomy operation but may sometimes be seen if the patient looks in the mirror and raises the upper eyelid.
It is uncommon for patients to feel any sensation from the presence of the drainage bleb.
You will be discharged home from hospital later the same day after surgery, or the following day. It is necessary for the operated eye to be examined one day after surgery. The eye will have a patch on after the operation, which is removed the following day.
It is normal for the vision to be blurred and the eye to be a little uncomfortable after surgery. Blurring of vision will be variable in severity and lasts for approximately 4-6 weeks. It takes about 2 months for the eye to feel completely normal and the vision to stabilise.
Success Rates
Long-term studies suggest that most people will achieve a low eye pressure without the need for additional glaucoma medication after trabeculectomy surgery.
In clinical trials, trabeculectomy has proven consistently more successful at lowering intraocular pressure than either medication or laser.The success rate of trabeculectomy varies according to a number of risk factors including the type of glaucoma, previous surgery, race, age and other conditions. In low risk patients, the success rate is over 90%.
A small percentage of patients will require further surgery for uncontrolled pressure.
Uncommonly, a patient will develop a pressure that is chronically too low, requiring further surgery to elevate the pressure.
Complications
Severe complications are rare, but may happen either if the eye pressure drops very low, or very quickly during the early post-operative period, or if the eye becomes infected.
If such complication does occur, further surgical intervention may be necessary and very occasionally, permanent loss of vision can result.