Trabeculectomy is a classic glaucoma surgical procedure that has been around for many years. Many modifications have been made to the procedure to make it safer and more effective for glaucoma patients. The procedure is done when reasonable efforts with medicine and laser have not been effective.
This surgical treatment is done in our Ambulatory Surgery Center and takes approximately one hour. The anesthesia used during the procedure is a combination of intravenous sedation (per the anesthesiologist) and periocular lidocaine. During the procedure, a small channel is made in the sclera connecting the anterior chamber of the eye with the subconjuctival space. This channel allows the flow of fluid to “bypass” the trabecular meshwork and to lower intraocular pressure.
Patients undergoing a trabeculectomy must be prepared to have blurred vision that lasts anywhere from 1-6 weeks with 2 weeks being the average. The pressure after the surgery can be high or low. High pressure can often be treated in the post-operative period with “suture lysis,” which utilizes a laser to open up the channel and allows a greater flow of fluids out of the eye. Low pressure is usually treated with a “red top” eye drop including Atropine® and Cyclogyl®. The pressure will usually rise on its own without further intervention. Rarely, a second procedure will have to be done to slow down the flow of fluid out of the eye.
Infection is a rare but serious complication after trabeculectomy. It is associated with a red, painful eye and decreased vision. If these symptoms occur, the office needs to be contacted immediately.
Glaucoma Tube Shunts
This surgical procedure is similar to a trabeculectomy in that the trabecular meshwork is bypassed and aqueous fluid is drained to an extraocular space. With a glaucoma tube shunt procedure, a small silicone tube is placed in the anterior chamber of the eye and fluid is drained to a “plate” where the fluid collects, then is re-absorbed into the body.
The complications to the procedure include infection and hypotony, or low pressure in the eye. Double-vision is also rarely encountered after the procedure. The technology of the tube shunts continues to improve and are proving to be an excellent procedure to control intraocular pressure and slow glaucoma progression.