Trabeculectomy

TRABECULECTOMY

Glaucoma is the world’s leading cause of irreversible loss of vision. It is estimated that 11 million people are blind worldwide; 23% of patients on the blind registry of locally is due to glaucoma. The strategies to treat glaucoma include drops, laser and other surgical procedures. Trabeculectomy is the commonest incisional procedure performed internationally for the past 30 years. This procedure is available to patients in the Caribbean including Trinidad and Tobago by trained, qualified surgeons.

 

What is trabeculectomy?

Trabeculectomy is a surgical procedure offered when glaucoma is advanced or there is progression of visual loss. Progression is assessed by a dilated examination of the optic nerve and/or visual field examination. Indications for trabeculectomy include:

1 Advanced glaucoma (tunnel vision)

2 Optic nerve progression

3 Visual field deterioration

4 Uncontrolled pressures in the eye.

 

Trabeculectomy aims to lower the intraocular pressure to reduce the risk of loss of vision. It effectively creates a microscopic release valve to lower the pressure which reduces the pressure on the nerve. Note, it will not restore vision lost from glaucoma; it aims to preserve vision.

Typically, an anti-scarring medication (Mitomycin C) is used to reduce scarring and increase the success of surgery.

 

Post-operative care.

The procedure takes approximately one hour to perform and can safely be done under local anaesthesia. You are discharged the same day and reviewed the next morning. The eye is patched overnight and removed the next morning by the surgeon.

Your glaucoma drops are continued until the day of the surgery. On the morning review your surgeon will start drops (antibiotics/anti-inflamatory) up to six times daily. It is not unusual for the pressures to fluctuate during the first few weeks hence there will be frequent reviews and sometimes additional drops/tablets.

 

Vision

The vision can be slightly blurred for the first 4 weeks after the surgery. It takes one month for the eye to feel normal and the vision to stabalize.

 

Success rates

International studies have shown that trabeculectomy is safe and effective at preserving vision long term. In clinical trials, trabeculectomy has proven consistently more successful at lowering the intraocular pressure than either medication or laser. In low risk patients success rates are over 90%. Naturally other factors such as age, race, previous surgery, inflammation etc can affect the results. Up to one third of patients require a combination of surgery and drops to maintain a low pressure. A minority require further surgery.

 

Complications

Severe complications are rare <0.5%. These include infection and too low pressures. You may also need to change your glasses; there is a small risk of cataract which can be safely treated by surgery if necessary.

 

Please discuss with your ophthalmic surgeon as the risk of going blind from glaucoma is significantly reduced by surgery and more importantly entirely preventable..

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