Contetns
What is Glaucoma?
Glaucoma is a condition usually caused by high pressure inside the eye. This pressure can damage the optic nerve, leading to vision loss if not managed properly.
Term | Explanation |
Glaucoma | A condition often caused by high pressure inside the eye, which can damage the optic nerve. |
Aqueous Humour | A fluid inside the eye that helps maintain eye pressure; different from tears which cause eye watering. |
Trabeculectomy | A surgical procedure that creates a small hole in the eye to drain aqueous humour and reduce eye pressure. |
Trabeculectomy Surgery Procedure
Trabeculectomy is a surgery designed to lower the intraocular pressure (IOP) in patients with glaucoma. The procedure involves creating a small hole in the white part of the eye (sclera), covered by a thin "trap-door." This "trap-door" allows the aqueous humour to drain from inside the eye to a small reservoir called a "bleb" under the surface of the eye, typically hidden under the upper eyelid.
Procedure Overview:
A small hole is made in the sclera.
A "trap-door" is created over the hole.
The aqueous humour drains slowly through this "trap-door."
The fluid collects in a bleb, reducing the intraocular pressure.
Important Points to Note
Aqueous Humour vs. Tears: Aqueous humour is not the same as tears. Tears are responsible for watering the eyes, while aqueous humour is a fluid inside the eye that maintains pressure.
Vision Loss Prevention: Reducing the eye pressure helps prevent further damage to the optic nerve. However, it does not restore vision already lost due to glaucoma.
Controlled Drainage: The "trap-door" is carefully sutured to ensure that the fluid drains at a controlled rate, preventing a sudden drop in eye pressure.
Trabeculectomy can be a crucial surgical option for patients with glaucoma to help control eye pressure and prevent further vision loss.
Send us your eye test results, and we will provide a free assessment to determine the most suitable surgery for you!
The Appearance of the Eye After a Trabeculectomy
Immediately After Surgery:
Following a trabeculectomy, the eye is initially red and swollen to varying degrees. The upper eyelid may also partially droop. These symptoms typically resolve over several weeks to a few months.
The drainage bleb, which is a small fluid-filled blister created by the surgery, is usually not visible to the naked eye. However, it may be seen if the patient looks in the mirror and lifts the upper eyelid.
Sensation of the Drainage Bleb:
Most patients do not feel any sensation from the presence of the drainage bleb after the surgery. In rare cases, if a patient becomes aware of the bleb and it causes discomfort, there are measures that can be taken to make it more comfortable. Further information on these steps can be found under the complications section.
Medication Prior to Surgery
Before undergoing surgery, patients are generally advised to continue all their eye drops and tablets as per their usual treatment regimen up until the morning of the operation.
Blood-thinning medications, such as Aspirin, Warfarin, and Clopidogrel, should also usually be continued. However, your clinician may advise you to stop taking blood-thinning medication before surgery to ensure it falls within the correct therapeutic range.
If patients choose to have the surgery under general anaesthesia, a pre-operative assessment of their overall health will be conducted shortly before the procedure. Any underlying medical conditions, such as heart disease, uncontrolled high blood pressure, and diabetes, must be managed before the surgery is scheduled.
Trabeculectomy surgery
Duration:
Trabeculectomy surgery typically takes about 45 to 60 minutes to complete.
Anaesthetic:
Trabeculectomy is usually performed under local anaesthetic, though it can also be done under general anaesthetic. For surgeries under local anaesthetic, the patient remains awake but may request light sedation to feel more comfortable.
The eye is numbed first with eye drops, followed by an injection of anaesthetic around the eye. This injection might cause mild discomfort, such as a slight pressure sensation, but it numbs the eye to prevent pain and excessive movement during the procedure.
During the surgery, patients are covered with a sterile sheet, or drape, to maintain a sterile environment and to prevent them from seeing the surgery. Although patients will be aware of the surgeon working around their eye, they should not feel any pain.
If any pain or discomfort occurs, the patient can calmly raise a hand, and the surgeon will pause the operation to administer additional anaesthetic if needed. Patients might also hear the surgeon talking to the scrub nurse and other members of the surgical team.
Ismail H., who underwent cataract surgery in 2007, was experiencing cloudy and blurred vision. He had been suffering from glaucoma for 20 years and was using eye drops, which led to the revocation of his driving license. To improve his vision, eliminate the need for eye drops, and regain his driving license, he contacted Medicalart Turkey.
Use of Mitomycin C (MMC) and Avastin:
Mitomycin C is a ‘cytotoxic’ agent, or anti-cancer drug, used in trabeculectomy to reduce scarring. It is typically applied with a sponge to the eye's surface and then rinsed off with saline to ensure none remains.
Occasionally, a tiny amount is injected beneath the outer layer of the eye wall and spread over the treatment area. The use of Mitomycin C in glaucoma surgery is considered 'off licence,' meaning it is not officially approved for this specific use by the manufacturers.
However, years of experience have shown it to be safe and effective, although there are some small risks, such as the eye pressure dropping too low.
Avastin is another drug initially developed for cancer treatment but is now widely used in eye surgeries. Some surgeons inject Avastin into the eye at the end of the procedure to help reduce scarring.
Send us your eye test results, and we will provide a free assessment to determine the most suitable surgery for you!
Trabeculectomy: After Surgery
Discharge and Follow-Up:
Patients are generally discharged to go home either on the same day as their surgery or the day after. All patients need to be examined the day after surgery, so those who have day-case surgery will need to return to the hospital the following day. Some hospitals may offer overnight accommodation for patients who are travelling from a distance.
Aspect | Details |
Discharge Timing | Patients are usually discharged either the same day or the day after surgery. |
First Follow-Up Appointment | All patients must return to the hospital the day after surgery for a check-up. |
Accommodation for Distant Travel | Some hospitals provide overnight accommodation for patients traveling from far distances. |
Eye Padding and Shield:
After surgery, the operated eye is usually padded, and this pad is removed the next day. If the unoperated eye has poor vision, the pad on the operated eye may be removed earlier. In such cases, a clear shield will be placed over the operated eye, allowing the patient to see through it post-surgery. The eye may appear bloodshot for a few days following the operation.
Trabeculectomy: Post-Surgery Eye Care
Care Element | Details |
Eye Padding and Shield | Eye is padded after surgery, and the pad is removed the next day; a clear shield may be used to protect the eye. |
Eye Appearance | The eye may appear bloodshot for a few days post-surgery. |
Transport Assistance | It is recommended to have someone accompany you home, especially if vision is compromised or under general anesthesia. |
Transport and Make-Up:
Patients are advised to have a friend or relative accompany them home, particularly if their unoperated eye has poor vision or if they underwent general anaesthesia. It is recommended to avoid wearing make-up for about four weeks after surgery, depending on individual recovery. When starting to use make-up again, it's best to buy new products and discard any previously used items to reduce the risk of infection.
What to Expect After Surgery:
It is normal for vision to be blurred, and for the eye to feel uncomfortable following surgery. The duration of blurriness can vary; typically, vision may be particularly blurred for one to two weeks and then gradually improve. It may take two to three months for the eye to feel completely normal and for vision to stabilise. Patients will be asked to wear a protective shield at night for the first two weeks to prevent accidental harm to the surgical site while sleeping.
Eye Soreness and Sutures:
Discomfort in the eye after surgery is partly due to the procedure itself and partly because of the sutures (stitches). The sutures are non-dissolvable and are usually removed in the clinic two to three weeks post-surgery. This process takes only two to three minutes and is done after numbing the eye with anaesthetic eye drops. The eye typically becomes more comfortable after the sutures are removed.
Trabeculectomy :Post-Surgery Expectations
Aspect | Details |
Vision and Blurriness | Blurry vision is normal; it typically lasts 1-2 weeks but can take 2-3 months for full stabilization. |
Nighttime Protection | A protective shield should be worn at night for the first two weeks to prevent accidental injury. |
Eye Soreness | Discomfort is common, partly due to the procedure and the non-dissolvable sutures. |
Suture Removal | Sutures are removed 2-3 weeks post-surgery, and the process takes only a few minutes under local anesthetic. |
Post-Operative Eye Drops:
Patients will be prescribed eye drops to use regularly after surgery, starting the day after the post-operative examination. It is generally not necessary to use eye drops on the first night after the surgery. Patients should stop using Acetazolamide (Diamox) tablets or any glaucoma medication in the operated eye unless otherwise advised. However, eye drops for the unoperated eye should be continued unless otherwise directed.
Post-operative eye drops usually include an antibiotic (e.g., Chloramphenicol) and an anti-inflammatory steroid (e.g., Dexamethasone). The steroid eye drop is typically used intensively (every two hours or about eight times daily), and the antibiotic four times daily.
Preservative-free drops are generally used during this intensive period. When drops are prescribed for intensive use after surgery, they are typically meant to be used only during the day. If overnight intensive use is needed, patients will be informed separately.
Patients are provided with a supply of post-operative eye drops upon leaving the hospital; this supply should last about one month. These drops usually need to be taken for two to three months, and the dosage may be adjusted at each post-operative visit. Patients should not stop using the drops or change the dosage without consulting their doctor.
Medication Type | Details |
Antibiotic (e.g., Chloramphenicol) | Used four times daily to prevent infection. |
Steroid (e.g., Dexamethasone) | Used intensively, about eight times daily, to reduce inflammation. |
Duration of Use | Typically used for 2-3 months; dosage may be adjusted during follow-up appointments. |
Acetazolamide/Glaucoma Medication | These medications are usually stopped in the operated eye unless advised otherwise by the doctor. |
Preservative-Free Drops | Often prescribed for use during the intensive post-op period. |
Post-Operative Clinic Visits:
Patients are typically seen once a week for the first four weeks after surgery but may need more frequent visits if the eye pressure is too high or too low. During these visits, sutures may be removed to adjust the pressure, and additional injections of steroids or 5-fluorouracil (a drug that reduces healing) may be administered around the eye to counteract the body's natural healing response. These injections are given after administering anaesthetic eye drops during the clinic appointment.
In some cases, if the wound is healing too much, it may be necessary to massage the eye or perform a procedure called needling. Needling is done after local anaesthetic eye drops are applied in the outpatient department. It is considered a safe and effective method of reopening the drainage tube and can be repeated if necessary. Patients have reported only minimal discomfort during this procedure.
Patients who live far from the hospital may be able to alternate their post-operative appointments between their surgeon and a local ophthalmologist.
Aspect | Details |
Frequency of Visits | Typically, patients have weekly check-ups for the first four weeks post-surgery. |
Pressure Adjustments | Sutures may be removed, or additional treatments may be needed to adjust eye pressure during these visits. |
Injections (Steroids, 5-Fluorouracil) | Administered if needed to control the body's healing response and ensure the drainage system remains open. |
Needling Procedure | A minor outpatient procedure to reopen the drainage tube if necessary, done under local anesthesia. |
General Recovery Guidelines
Avoid Makeup: No makeup for about four weeks after surgery to avoid the risk of infection.
New Products: When starting makeup again, buy new products and discard previously used items.
Vision Stabilization: Vision can be blurry for 1-2 weeks, and may take up to three months to stabilize fully.
Contact Lens Use After Trabeculectomy Surgery
It is usually possible to resume wearing contact lenses around four weeks after trabeculectomy surgery, and sometimes even sooner. However, not everyone can continue to wear contact lenses following this procedure, so it is an important factor to consider before deciding to undergo trabeculectomy surgery. If wearing contact lenses is essential for the patient, other alternatives to trabeculectomy may need to be considered.
The ability to wear contact lenses after surgery largely depends on the appearance and shape of the drainage bleb. The surgeon will typically be able to provide advice on whether contact lenses can be worn by six to eight weeks after surgery.
When is the Eye Back to Normal?
It can take approximately two to three months for the eye to feel completely normal and for vision to fully stabilise. During this time, patients should avoid changing their spectacles, as the eye is still in the process of healing and adjusting.
Activity After Surgery
It is important to avoid strenuous activities in the early post-operative period. This includes swimming, tennis, jogging, and contact sports. Watching television and reading are safe and will not harm the eye.
For those who wish to pray, it is advisable to kneel without bowing the head down to the floor for the first two to three weeks, as bending over can cause significant pain while the eye is still inflamed. Similarly, activities such as yoga that involve head-down positions should be avoided.
As patients will be closely monitored after surgery, it is recommended to consult the surgeon before resuming any strenuous activity. If the eye pressure is very low after surgery, the surgeon may advise against all exertion and suggest remaining sedentary until the pressure is restored.
When Can I Go Back to Work or School?
The amount of time needed off work or school will depend on several factors, such as the nature of the patient's job, the state of vision in the other eye, and the pressure in the operated eye. Typically, someone working in an office environment would require about two weeks off, assuming a smooth post-operative recovery.
For those whose occupations involve heavy manual labour or working in dusty environments, such as builders or farmers, a month or more may be necessary. This can be discussed with the consultant.
Flying After Surgery
Although it is safe to fly after trabeculectomy surgery, patients should bear in mind that the surgeon will want to see them for a number of post-operative visits to ensure that the eye pressure is maintained at the correct level.
Success Rates of Trabeculectomy
Success Rate Factors | Details |
Long-term effectiveness | Most patients achieve lower eye pressure without additional medication post-surgery. |
Comparison to other treatments | More effective at lowering intraocular pressure than medication or laser treatments.¹,² |
Study on success after 20 years | 90% success rate; 2/3 of patients did not need medication, 1/3 required medication.³ |
Need for further surgery | About 10-12% of patients may require additional surgery for uncontrolled pressure. |
Risk of very low pressure | Rare cases of eye pressure dropping too low may require further surgery to elevate pressure. |
Complications of Trabeculectomy
Early Post-Operative Complications
Complication | Details | Frequency |
Very low eye pressure (hypotony) | May cause aching or throbbing in the eye; can lead to choroidal hemorrhage if untreated (very rare). | Most common in the first few weeks |
Blurring of vision or visual distortion | These are warning signs that need immediate medical attention. | Rare |
Return to operating room | About 5% of patients require a second surgery within the first month to adjust eye pressure. | 5% |
Long-Term Complications
Complication | Details | Frequency/Impact |
Infection | Rare, but there is a lifelong risk of infection in the drainage bleb. | 1 in 250 chance of infection⁴ |
Discomfort from drainage bleb | Can cause dryness or discomfort in 10% of patients; usually treatable with artificial tears. | 10% |
Cataract formation | Increases the likelihood of developing a cataract. Study showed 20% of patients needed cataract surgery within 7.7 years.² | 20% within 7.7 years |
Changes in glasses prescription | Patients may need a small adjustment in glasses prescription; avoid changes until 3 months post-op. | Rare need for new glasses |
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