Trabeculectomy is a type of surgery done in the front part of your eye. It’s done to treat glaucoma by lowering the pressure in your eye.
The front part of your eye is full of fluid. (This is the area in front of the colored part of your eye, the iris.) Normally, this fluid slowly drains out of your eye through a network of channels, out into the veins of your body.
In glaucoma, fluid may pass too slowly out of this drain. This can cause the pressure in your eye to increase. This increases pressure on your optic nerve, which is important for sending visual information to your brain. If the pressure increases too much, it can damage your optic nerve. This causes vision loss.
During trabeculectomy, your surgeon makes a new opening for fluid to leave your eye. After numbing your eye, your surgeon removes a small piece of tissue from the part of your eye where the fluid drains out. This allows the fluid to bypass the normal channel out of your eye. A flap of tissue from your sclera (the white part of your eye) and the conjunctiva (the thin layer covering your eye) partly cover this opening. This can help lower pressure inside your eye. This can help prevent future vision loss.
You might need this procedure if you have glaucoma that you have not been able to control with eye drops or laser treatment. Without treatment, people with glaucoma lose their side (peripheral) vision over time. Less commonly, central vision may decrease too. This can cause a person to become totally blind.
Your eye healthcare provider (ophthalmologist) might advise trabeculectomy to help keep your glaucoma from getting worse. However, it does not restore vision that has already been lost. Trabeculectomy is a possible treatment for both closed-angle and open-angle types of glaucoma. It is also a possible treatment for primary and secondary types of glaucoma.
Your eye healthcare provider might want to try other treatments first before performing a trabeculectomy. For example, he or she may want to try medicines to lower the pressure in your eye. Another procedure, called laser trabeculoplasty, is also a choice for some people. If these treatments don’t work, your eye healthcare provider may recommend trabeculectomy. Surgical placement of a shunt is another potential surgery for some people.
Each of these treatment choices has its own risks and benefits. Ask your eye healthcare provider why trabeculectomy might make sense for you.
Many people do well with their trabeculectomy. However, complications from the surgery can sometimes happen. Some possible risks include:
- Tearing of the conjunctiva
- Tearing of the sclera (this is rare)
- Excessive bleeding
- High pressure inside the eye
- Abnormally low pressure inside the eye
- Bleeding into the eye
- Eye infections
There is also a risk that the trabeculectomy will not be effective. If this happens, you might need a repeat surgery.
Your risks may differ according to your age, your other health conditions, and the specific anatomy of your eye. Talk with your eye healthcare provider about all your concerns and about the risks that apply to you.
Talk to your eye healthcare provider about how to prepare for your trabeculectomy. Ask whether you need to stop taking any medicines before the procedure. You will need to avoid eating or drinking anything after midnight before the day of the surgery.
Your eye healthcare provider may want certain tests before the procedure, to get a better idea of the anatomy involved. These might include:
- Dilated eye exam
- Tonometry to measure the pressure inside the eye
- Pachymetry to measure the thickness of the cornea
Talk with your eye healthcare provider about what will happen during your trabeculectomy. An eye healthcare provider (ophthalmologist) usually performs the surgery. In general, you can expect the following:
- You may be awake during the surgery. You will receive a medicine to help you relax. You may also receive an injection or a topical numbing medicine (anesthetic) to numb the area. This will keep you from feeling anything during the surgery.
- In other cases, you may receive sleep medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
- You may receive an antifibrotic medicine on your eye during and after the surgery. This can help reduce scarring and the chance for complications.
- Your surgeon may rotate your eye during the surgery and temporarily secure it with a stitch.
- Your surgeon will make an incision at an angle along the conjunctiva on the side of your eye.
- Your surgeon will make an incision partway through your sclera, making a flap. The incision will connect all the way to the cavity containing the fluid in the front of your eye. The surgeon will remove a small piece of tissue from the part of the eye where fluid drains out.
- Your surgeon will make a small hole in your iris.
- Your surgeon will close the area and remove the stitch that was rotating your eye.
- You may receive antibiotics in your eye.
- Your eye may be covered and taped shut.
Ask your eye healthcare provider about what you should expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone drive you home from the procedure.
Be sure to follow your eye healthcare provider’s instructions about caring for your eye. You may need to take antibiotics to help prevent infection. You may also need other medicines, like steroids or antifibrotics. You may need to continue to cover your eye for a while after your surgery.
The area may be a little sore after the procedure, but you should be able to take over-the-counter pain medicines. Ask your eye healthcare provider whether you should avoid any specific activities while you recover.
You will need close follow-up with your eye healthcare provider to see whether the surgery was effective. You may have a scheduled appointment the day after the procedure. Your eye healthcare provider will need to make sure the new drainage opening is functioning well.
You will need continued follow-up care to monitor how you are doing after your surgery. You may need to have stitches in your eye removed in a follow-up appointment a few weeks after your surgery. Be sure to tell your eye healthcare provider right away if you have bleeding, fever, worsening vision, increasing eye pain, or swelling.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Haupert, Christopher L., MD,Walton-Ziegler, Olivia, MS, PA-C