When is a Trabeculectomy Necessary?

If medications and laser therapies do not adequately lower eye pressure, your doctor may recommend conventional surgery. Of the possible procedures, glaucoma filtration surgery, also called a trabeculectomy, which is used in both open-angle and closed-angle glaucoma, is the most common.

How is a Trabeculectomy done?

A trabeculectomy is an outpatient procedure in which the surgeon creates a passage in the sclera (the white part of the eye) for draining excess eye fluid. A filtration bleb, or reservoir, is created under the conjunctiva, which is the thin and clear coating that covers the sclera. The aqueous humor inside the eye is then able to drain through the flap to collect in the bleb. There is it absorbed into the lymph and blood vessels around the eye. After the bleb is carefully constructed, the incision is closed with tiny stitches. After surgery, some of these stitches may be removed to increase fluid drainage. Usually, drugs to reduce scarring are applied during and after surgery.

What to Expect if one has a Trabeculectomy?

With a trabeculectomy, postoperative care is as important to the long-term success of the operative as the surgery itself. During follow-up appointments, your ophthalmologist will examine the filtering bleb, the external appearance of the eye, your eye pressure, and the back of the eye. One should avoid lifting, bending, or straining after surgery until the eye pressure stabilizes.

Pain is unusual after surgery, although it is normal for your eye to feel some tenderness and sensitivity. Any sudden, severe or deep-seated pain, especially if associated with vision loss, should be reported to your ophthalmologist immediately.

Generally, vision is blurry for several weeks after surgery and this may fluctuate daily. There may or may not be a change in one’s eyeglass prescription after surgery. If a cataract or other complication is present, vision may not return to what it was before surgery. Surgery cannot restore vision already lost from glaucoma.

Possible Complications

As with any surgery, there are risks associated with a trabeculectomy. Other possible complications are as follows:

  • Infection
  • Bleeding
  • Wound leakage
  • Over filtration
  • Cataract
  • Loss of vision

Although the success rate is quite high, sometimes a single surgical procedure can not stop the progression of glaucoma. Another surgery and/or continued treatment with medications may be necessary.