Trabeculectomy takes about 4-6 weeks to heal completely.
Unlike laser surgery, trabeculectomy takes about 4-6 weeks to heal completely. Vision may be blurry for about 6 weeks. About 50% of patients undergoing this surgery most probably don’t require medications to lower intraocular pressure.
What is trabeculectomy?
Trabeculectomy, also known as filtration surgery, involves surgical removal of a mesh of tissue from ‘angle of the eye.’ The angle is the space between the iris (colored part of the eye) and sclera (white of the eye). Trabeculectomy reduces the intraocular pressure-formed due to glaucoma.
Why is trabeculectomy indicated?
Trabeculectomy may be indicated to treat the following conditions:
- Primary open-angle glaucoma
- Primary angle-closure glaucoma not responsive to laser surgery
- Secondary open-angle glaucoma
- Secondary angle-closure glaucoma
- Childhood glaucoma (glaucoma present at birth)
Glaucoma is a condition that damages the optic nerve in the eye due to the buildup of the pressure. It is the leading cause of blindness for people above 60 years of age. There are two major types of glaucoma:
Open-angle glaucoma: This is the most common form of glaucoma. In this condition, the drain structure (trabecular meshwork) in the eye is fine, but it doesn’t drain the fluid completely.
Angle-closure glaucoma: Also called acute or chronic angle-closure or narrow-angle glaucoma, the drain space between the iris and cornea of the eye becomes too narrow to drain the fluid.
Secondary glaucoma: Conditions, such as diabetes or cataract, cause added pressure to the eye leading to secondary glaucoma. They can be of two types:
- Secondary open-angle glaucoma
- Secondary angle-closure glaucoma
Normal-tension glaucoma: Blind spots in the vision or optic nerve may build eye pressure.
Pigmentary glaucoma: A tiny portion of pigment from the iris, which is the colored part of the eye, travels through the fluid in the eye and clogs the drainage canal.
When should be trabeculectomy avoided?
Trabeculectomy should be avoided in the conditions where the risks outweigh the potential benefits.
Generally, trabeculectomy is avoided in:
- Previously failed trabeculectomy
- Severe scarring of tissues that line the inside of eyelids and white (sclera) of the eyes
- Neovascular glaucoma: It is a type of secondary glaucoma, where a new blood vessel closes the angle of the eye.
- Uveitic glaucoma: This glaucoma is caused due to inflammation of the middle layer of the eye (uveitis).
- Eyes with no sight
How is trabeculectomy performed?
The surgery is done under local or general anesthesia depending on the person’s age and anxiety levels.
The eyeball is fixed in place and the surgery is done using a microscope, surgical tools, and cautery.
In this surgery, the physician creates a small opening in the angle of the eye by removing a piece of tissue from the area where the colored part of the eye (iris) and sclera (whites of the eye) meet. This new opening allows the drainage of fluid, which bypasses the clogged drainage channels.
As the fluid drains through the new openings, the pressure inside the eye reduces.
Sometimes, a thin tube may be placed at the site of the cut to facilitate proper drainage of fluid. Stitches may be placed at the site of the cut. These are removed in the second or third follow-up.
What to expect after trabeculectomy surgery?
Antibiotics may be injected under the conjunctiva. The eye doctor will examine your eyes the day after surgery and may schedule follow-up visits 1 or 2 weeks apart. In follow-up visits, the doctor will screen your vision and check for wound healing. Eye pressure will be checked as well.
The vision may remain blurry for 6-8 weeks after the surgery. You may have slight pain or discomfort in the eye for a few days. If the pain is unbearable and the eye appears red, contact the doctor immediately.
You may have to use an eye shield for a month after the surgery. The application of corticosteroids for about 1-2 months after the surgery would be recommended by the physician. No swimming, contact sports, or extreme workout should be done. You must not rub your eyes at any point.