Trabeculectomy glaucoma surgery

Trabeculectomy is a surgical procedure designed to lower intraocular pressure (IOP) in cases of glaucoma. Glaucoma is a disease that damages the optic nerve and can lead to vision loss, often due to excessively high IOP. This surgery is considered when medication fails to adequately control the pressure, causes intolerable side effects, or when a more significant pressure reduction is required to prevent further optic nerve damage. The goal of the surgery is to preserve existing vision and prevent further deterioration, but it cannot restore vision already lost due to nerve damage.

The surgery is typically performed under local anesthesia, using numbing eye drops and sometimes a local injection. During the procedure, the surgeon creates a tiny opening in the wall of the eye, usually in the upper part of the eyeball, beneath the eyelid. This opening serves as an alternative drainage pathway for the aqueous humor, allowing it to exit the eye and collect under the conjunctiva, which is the clear membrane covering the white of the eye. This collection forms a small blister like area called a 'filtering bleb.' From the bleb, the fluid is gradually absorbed into the surrounding blood vessels, thereby reducing the intraocular pressure. The opening is partially closed with fine sutures, which allow for control over the drainage rate.

Anti scarring medicines may be applied during surgery, for example using a sponge or an injection, and further injections may be needed afterward. This is because the body naturally tends to heal wounds by forming scar tissue, and scarring in the new drainage pathway can block it, leading to a re elevation of intraocular pressure. These agents help maintain the patency of the drainage pathway over time. Scarring is more common in younger patients or those who have used many glaucoma eye drops for an extended period, leading to irritation and redness in the eyes before surgery.

Before surgery, it is crucial to discuss all regular medications with your doctor, especially blood thinners. You may need to temporarily stop these medications to reduce the risk of bleeding during the procedure. Your doctor will provide precise instructions regarding fasting, if required, and any other necessary preparations. It is important to arrive for surgery feeling calm and with an escort, as vision may be blurry immediately after the procedure.

After surgery, the eye will be covered with a shield or patch for one day. You should avoid heavy lifting, bending over, and strenuous physical activity for about two weeks or more, as directed by your doctor. Typically, glaucoma medication for the operated eye will be discontinued. You will need to instill antibiotic eye drops to prevent infection and steroid eye drops to reduce inflammation and prevent scarring, according to a precise schedule provided by your doctor. It is important to protect the eye from rubbing or pressure, especially during sleep, using an eye shield for about two weeks.

Close follow up is required after surgery. The first assessment is arranged within the early postoperative period and may be the next day; repeated visits can be needed frequently, with timing determined by your surgeon and eye pressure rather than a fixed interval. During these visits, adjustments such as laser suture lysis or additional injections of anti scarring agents may be necessary to maintain the function of the filtering bleb. Potential complications include excessively low intraocular pressure (hypotony) or excessively high pressure, scarring of the filtering bleb, bleeding, infection, fluid leakage from the surgical site, or cataract progression. In rare cases, vision loss may occur. If scarring occurs, repeat surgery or additional treatments may be needed.

A filtering bleb carries an ongoing risk of infection, even many years after surgery. Seek urgent eye care immediately for a new red or painful eye, discharge, swelling or a decrease in vision. Do not wait for a routine appointment or assume that these signs are harmless because the operation was long ago. A bleb infection can spread inside the eye and threaten vision, so early treatment matters.