Trabeculectomy

Glaucoma, an eye condition, is caused due to accumulation of aqueous humour in the eye. This fluid accumulation increases the pressure in the eye that damages the optic nerve, resulting in loss of vision. Trabeculectomy is eye surgery that helps drain the accumulated fluid from the eye and reduce the pressure inside the eye.

The benefits of trabeculectomy are:

1. It is a safe procedure/surgery.
2. It lowers the intraocular pressure (IOP) or pressure inside the eye.
3. It protects the vision by reducing the IOP and preventing further optic nerve damage.

Individuals with glaucoma need trabeculectomy surgery. This surgery is done for individuals with:

1. Primary glaucoma (developed due to unknown cause)
2. Secondary glaucoma (known reasons like inflammation and eye injury increase the eye pressure that damages the optic nerve)
3. Open-angle glaucoma (The drainage canals of the eye become blocked, damaging the optic nerve)
4. Closed-angle glaucoma (The angle in the majority of areas between the cornea and iris is closed, which lowers the drainage of fluid and increases pressure inside the eye)
5. Progressive glaucoma (glaucoma that continues even after laser treatment or eye drops.

1. High pressure in the eye due to glaucoma can damage the optic nerve, resulting in vision loss.
2. If the surgery is delayed, people with glaucoma may:
3. Lose peripheral vision, also called indirect vision (the vision away from the centre of gaze) 
4. Lose central vision (focus on a particular object)
5. Have complete blindness

Trabeculectomy involves the creation of a fistula connecting the subconjunctival space and the anterior chamber. It provides an alternative pathway for the filtration of aqueous humour if the natural trabecular outflow pathway is functioning poorly or blocked (in the case of glaucoma).

Your eye surgeon will:

1. Make a flap in the sclera.
2. Create a pathway under the flap to allow fluid drainage and reduce the eye's pressure.
3. Again, place the flap against the sclera to secure the drainage pathway.

The fluid leaks out into the space in the eye's outer lining and gets collected under the eyelid as a bleb (tiny blister of fluid). The surgery mostly takes 45-75 minutes.

Your ophthalmologist will tell you to stop taking any medications (mostly blood thinners) before the surgery.

Position during surgery:

For trabeculectomy, you will be kept in a supine position (lying horizontally facing up).

Cleaning and draping:

1. An antiseptic solution will be used to clean the surgical area/site.
2. Other than the surgical site, the rest of your body will be covered with a sterile cloth to lower the risk of infection.

You can expect the following during surgery:

Your doctor will: 

1. Inject anaesthetic to numb the eye or give you medicine to help you relax so that you are awake during the surgery.
2. Administer general anaesthesia in some instances so that you are asleep during the procedure.
3. Put an antifibrotic medication during and after the surgery. These medications lower the chances of surgery failing and the development of scarring tissue in the eye.
4. Rotate/turn your eye during the surgery and secure it temporarily by stitching it.
5. Put some antibiotics in your eye.

The recovery process in the hospital:

1. Your surgeon will cover and tape your eye after surgery.
2. You will be instructed to keep the patch till you meet your doctor again.
3. You will be allowed to go home the same day of surgery (in most cases).
4. Plan to have somebody drive you home after the surgery.
5. The care team will guide you to take over-the-counter pain medications.

The recovery process at home:

1. While sleeping, cover your eye with a shield to avoid accidental pressing of the eye.
2. Take steroid eye drops to prevent scarring and boost healing.
3. Avoid rubbing your eye.
4. Avoid vigorous/straining exercise and heavy lifting.
5. Avoid swimming.
6. Avoid bending below your waist until directed by your doctor.
7. You will have to take around two weeks off from work in most cases.

First Follow up Appointment

You have to visit your doctor the next day after the surgery. Your follow up intervals will vary depending on your clinical state. You might have to regularly see your doctor for at least a week after the surgery. Later, you must visit the doctor every one to two weeks and after that, two months after the surgery.

Possible side effects that can normally occur after the surgery:

1. Pain
2. Allergic reactions to medication, materials, or equipment.

Risk/complications of the surgery:

1. Cataract
2. Fluid leakage from the surgery site
3. Blurry vision
4. Surgery failure (unable to manage the pressure inside the eye)
5. Bleeding inside the eye

Sequelae of infection/complication:

There is a possibility of developing an infection at the surgery site that may cause loss of vision if not identified and treated quickly).