Trabeculectomy is a surgical intervention for the treatment of glaucoma. It is performed as a treatment when standard and pharmacological treatments are not sufficient, or in cases where standard treatments are not tolerated by the patient.
What is trabeculectomy?
It is a filtering intervention, which creates a "by-pass" between the inside and the outside of the eye (beneath the conjunctiva, covered by the upper eyelid), in order to drain the excess aqueous humour in the subconjunctival spaces of the interior of the eye and decrease the eye pressure. This enables one to limit the progression of glaucoma.
In Humanitas it is possible to intervene with a more simplified variant of trabeculectomy through the use of a microscopic plant valve known as "Ex-PRESS®".
How is trabeculectomy performed?
The surgery is performed with the use of local anaesthesia and it usually requires an overnight hospital stay for observation and check-ups the next morning.
In technical terms, the surgery is performed by initially removing a piece of tissue in the drainage angle of the eye, creating an opening. Then the opening is partially covered with a tissue flap from the sclera (the white part of the eye) and the conjunctiva (the clear thin covering over the sclera). The newly constructed opening allows fluid to drain out of the eye and bypass the clogged drainage channels.
What are the advantages and disadvantages of trabeculectomy?
The decision to intervene with trabeculectomy surgery depends on the stage and progression of the disease. The treatment enables one to limit the progression of glaucoma and allows patients to improve their quality of life, by suspending the drug therapy with eye drops.
On the other hand, the most common complication that occurs after a trabeculectomy is scarring of the opening, which interferes with normal function and prevents proper fluid drainage from the eye.
Other complications that may occur after surgery include:
- Bleeding in the eye
- Infection in the eye
- Blurred vision
- Sudden, permanent loss of central vision
- High pressure in the eye that leads to malignant glaucoma
Late complications of a trabeculactomy may include:
- Infection in the eye
- Droopy eyelid
- A cataract that is worse than it was prior to the surgery
- Continuous changes in the nerve at the back of the eye associated with glaucoma.
Is trabeculectomy painful and/or dangerous?
The surgery does not cause any pain, because it is performed under local anaesthesia. After the anaesthesia wears off, the patient may feel a little discomfort, due to the stitches.
Which patients can undergo a trabeculectomy?
The intervention is suitable for almost all patients, with the exception of cases of end-stage glaucoma, as it would not benefit the patient in any way.
In the first two months of follow-up care, the visits are scheduled weekly. From the third month on, remote reprogramming controls are variable relative to the postoperative course of progress.
Standard of preparation
The patient should instil eye drops as prescribed by doctors of the Glaucoma Centre who performed check-ups in previous visits. On the day before the surgery, the patient must undergo additional tests for the verification of ocular pressure and the overall monitoring process.