Overview of Trabeculectomy | Ophthalmology

Trabeculectomy

What is trabeculectomy?

Trabeculectomy is a surgical procedure to treat glaucoma. Glaucoma occurs when the fluid produced by the eye, called aqueous humor, cannot flow normally. It causes an increase in intraocular pressure (IOP) over time, which can lead to vision loss or blindness if left untreated.

Trabeculectomy lowers the intraocular pressure (IOP) in your eye. It can slow or stop vision loss caused by glaucoma. Your doctor may recommend a trabeculectomy if your IOP does not respond to standard glaucoma treatments, such as eye drops or prescription medications.

Trabeculectomy is used to create a new canal or “blister” through which fluid flows from the eye. Restoring the eye’s ability to drain fluid lowers IOP.

It does not cure glaucoma-related vision loss that you experienced before the procedure, but it can help delay or stop progressive vision loss later in life.

Who should have a trabeculectomy?

Before considering any surgical surgery, most ophthalmologists will seek medical treatment first, as any surgery will not be without risk. Glaucoma is most patients can be well controlled with pressure-reducing eye drops and often do not require surgery. Trabeculectomy is recommended when eye drops and/or laser treatments are not working.

Sometimes there are barriers to drug use – for example, side effects, cost, or physical illness can prevent a patient from using topical treatment such as glaucoma eye drops.

The potential benefits of overcoming the surgical risks are often referred to as trabeculectomy. It aims to control high intraocular pressure that causes progressive damage to the optic nerve and loss of vision.

Risk factors

Although trabeculectomy is considered a safe and effective procedure, there are some risks. In addition to:

  • Postoperative infection
  • Moisturizes the eyelid
  • Dual focus
  • Inflammation
  • Bleeding
  • Well development near the operating site
  • Low IOP (hypotonia)

In severe cases, some people experience:

  • Bleeding inside the affected eye
  • Choroidal detachment
  • Sight loss
  • Very rarely, eye loss
  • One in 250 people experiences choroidal detachment

The most common risks of low IOP surgery and scarring. Low IOP is a risk factor for choroidal detachment. The affected eye may have mild pain or symptoms of a sore throat. It can be difficult to detect, but your surgeon can correct it by tightening the stitches or adjusting your action to increase the IOP.

If the blister heals too quickly or if you develop scar tissue that interferes with fluid drainage, your ophthalmologist may need to massage or reopen the site through a procedure called a puncture. This patient procedure is performed under local anesthesia and can be safely repeated as needed. You may also receive steroid injections into the eye and medications that slow down the healing process.

How to prepare for a trabeculectomy?

As with any surgery, it is important to prepare in advance. Your eye surgeon will give you detailed instructions on how to prepare, but in the meantime, here are some steps you can take:

Inform your ophthalmologist about any medications you are taking. Continue with eye drops and prescription medications unless directed by your ophthalmologist

Receive treatment for conditions such as blepharitis (inflammation of the eyelids) to reduce the risk of postoperative infection.

What happens during a trabeculectomy?

Trabeculectomy is a type of surgery that removes part of the trabecular meshwork, the area of ​​tissue in the eye responsible for draining aqueous humor from the eye (which maintains normal intracellular pressure).

This surgery usually takes 45 to 60 minutes, often under local anesthesia, during which the surgeon carefully removes some tissue and creates a flap in the sclera (the white layer of the eyeball). This flap is designed to prevent all the liquid from leaking out too quickly and is sewn to act as an adjustable valve. The points can be painlessly released to achieve the target pressure in the eye.

Surgery is always performed under the upper eyelid, and the area above it becomes a reservoir of watery fluid (called a blister). When the top cap is lifted, it looks like a bubble, but completely normal.

Sometimes the formation of scar tissue closes the newly created drainage channel, which means that the pressure inside the eye is no longer reduced. Eye surgeries can use a powerful agent called mitomycin-C during surgery.

After trabeculectomy, it is not uncommon for the eye to experience a watery, gritty sensation. The eye may be red and swollen and may cloud vision for a few days. The stitches can cause temporary pain and irritation, but all of these usually disappear within a few days. If the eyelid is blotchy, it usually resolves over time. In general, there is no feeling of having a draining glow.

How is a trabeculectomy performed?

Your procedure is completed in the operating room and can be performed under local or general anesthesia. If you receive local anesthesia, your eye will go numb. If you are given general anesthesia, you will be given an IV for anesthesia. If you are receiving local anesthesia, your doctor may have prescribed a sedative ahead of time to facilitate relaxation.

His eye is cloudy, clean, and the eyelid is fitted with a speculum. Then you are covered with a curtain that reveals nothing but your eye. During the procedure, you will know that the surgeon is working, but you will not feel anything.

Your surgeon will open the blister at the top of the eye. It occurs under your eyelid, so it is not visible after the procedure. Once a new drainage site has been created, your surgeon will place stitches intended to keep the “flap” open close to the site, as the site must not be repositioned during healing. Your stitches will not melt and your doctor will need to remove them in two weeks.

The surgery should last between 45 and 60 minutes. After the procedure, your eye will be glued and protected until your next appointment with your surgeon the next day.

What is the success rate of trabeculectomy?

Long-term trabeculectomy has been shown to have a high success rate. An estimated 90 percent are successful, and two-thirds do not need medication to control the condition later.

About 10-12% of people who have a trabeculectomy require a repeat procedure. Research indicates that 20 percent of trabeculectomy procedures fail to control IOP for more than 12 months, and 2 percent of procedures fail each year after that time limit. For this, the people with the highest confidence risk are those who have artificial lenses and are covered with blisters.

Recovery

After surgery, immediate side effects include discomfort and blurred vision in the affected eye. The clouding lasts up to two weeks, but it may take up to 12 weeks for your eye to feel normal and see normally again. The surgery site and the stitches hurt, but they hurt after the stitches are removed.

For the first two weeks after the procedure, you will sleep with a shield over your eye, but the surgery site will heal to prevent injury overnight. After that, your surgeon will remove the stitches in the office. Your eye will be numbed with drops to remove them.

You will have regular follow-ups to check healing and progress and to monitor IOP in the affected eye. After the postoperative period, most people who have had surgery do not need eye drops. Your ophthalmologist will advise you if you should continue taking additional glaucoma medications.

For two to three months after surgery, you should follow a strict routine of applying prescription antibiotic and steroid eye drops throughout the day. Your doctor will prevent you from taking your usual glaucoma medicine in the affected eye after surgery.

When you recover, you should avoid strenuous activities such as sports, swimming, and high-impact exercise. Also, you should avoid activities like reversing, bending over, or squatting, such as yoga. Lowering the head can cause severe pain in the affected eye. Activities like reading and watching television are safe. Consult your ophthalmologist to find out when it is appropriate for you to resume your normal activities.

Depending on your job and the industry you work in, you may also need to see your doctor when you return to work. Two weeks may be an appropriate recovery period for office workers. Most people need more time before going back to hard work.

Post-operative results vary greatly from person to person, so trust your ophthalmologist to guide you step-by-step through your own recovery process. Because recovery looks so different for each person, your doctor may not be able to project what your track is.

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