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Trabeculectomy

What is trabeculectomy?

Trabeculectomy is a type of surgery to treat glaucoma. It lowers the pressure in your eye. This procedure may be advised when other treatment has not worked.

The front part of your eye is full of fluid. This is the area in front of the colored part of your eye, called the iris. Normally, this fluid slowly drains out of your eye through a network of tubes. It goes out into your veins.

When you have glaucoma, fluid may drain too slowly. This can cause the pressure in your eye to increase. This increases pressure on your optic nerve. This nerve is important for sending visual information to your brain. If the pressure increases too much, it can damage your optic nerve. This may cause vision loss.

During trabeculectomy, your surgeon makes a new opening for fluid to leave your eye. First, your eye is numbed. Then your surgeon removes a small piece of tissue from the part of your eye where the fluid drains out. This creates a new drain for your eye. This can help reduce the pressure inside your eye. This can help prevent future vision loss.

Why might I need trabeculectomy?

You might need this procedure if you have glaucoma that you have not been able to control with treatments such as eye drops or laser treatment. Without treatment, people with glaucoma lose their side (peripheral) vision over time. Less commonly, central vision may decrease, too. This can cause blindness.

Your eye care provider (ophthalmologist) might advise trabeculectomy to help keep your glaucoma from getting worse, but it does not restore vision that has already been lost. Trabeculectomy is a possible treatment for both closed-angle and open-angle types of glaucoma. It's also a possible treatment for primary and secondary types of glaucoma.

Your eye care provider might want to try other treatments first before doing a trabeculectomy. For example, they may want to try medicines to lower the pressure in your eye. A procedure called laser trabeculoplasty is also a choice for some people. If these treatments don’t work, your eye care provider may advise trabeculectomy. Surgical placement of a tube (shunt) is another possible surgery for some people.

Each of these treatment choices has its own risks and benefits. Ask your eye care provider why trabeculectomy may be the most effective treatment for you.

What are the risks of trabeculectomy?

Many people do well with trabeculectomy. But complications from the surgery can sometimes happen. Some possible risks include:

Tearing of the conjunctiva
Tearing of the sclera (this is rare)
Excessive bleeding
High pressure inside the eye
Abnormally low pressure inside the eye
Eye infection
Cataract
Scarring

There is also a risk that the trabeculectomy will not be effective. If this happens, you might need a repeat surgery.

Your risks may be different according to your age, your other health conditions, and the specific anatomy of your eye. Talk with your eye care provider about all your concerns. Ask about the risks that apply to you.

How do I get ready for trabeculectomy?

Talk with your eye care provider about how to get ready for your trabeculectomy. Ask if you need to stop taking any medicines before the procedure. Follow any directions you are given for not eating or drinking before the surgery.

Your eye care provider may want certain tests before the procedure. These might include:

Dilated eye exam
Tonometry to measure the pressure inside the eye
Pachymetry to measure the thickness of the cornea

What happens during a trabeculectomy?

Talk with your eye care provider about what will happen during your trabeculectomy. In general, you can expect the following:

You may be awake during the surgery. You will get medicine to help you relax. You may also get a shot (injection) or a topical numbing medicine (anesthetic) to numb the eye. This will keep you from feeling anything during the surgery.
In other cases, you may be given medicine (general anesthesia) to put you to sleep. If this is the case, you will sleep deeply during the surgery. You won’t remember it afterwards.
You may get an antifibrotic medicine on your eye during and after the surgery. This can help reduce scarring. It can also reduce the chance for complications.
Your surgeon may rotate your eye during the surgery. They temporarily secure it with a stitch.
Your surgeon will make a cut (incision) at an angle along the conjunctiva on the side of your eye.
Your surgeon will make an incision partway through your sclera, making a flap. The incision will connect all the way to the cavity containing the fluid in the front of your eye. The surgeon will remove a small piece of tissue from the part of the eye where fluid drains out.
Your surgeon will make a small hole in your iris.
Your surgeon will close the area. They remove the stitch that was rotating your eye.
You may get antibiotics in your eye.
Your eye will be covered with a patch.

What happens after a trabeculectomy?

Ask your eye care provider about what to expect after your surgery. In most cases, you will be able to go home the same day. Plan to have someone drive you home from the procedure.

Follow your eye care provider’s instructions about caring for your eye. You may need to take antibiotics to help prevent infection. You may also need other medicines, such as steroids or antifibrotics. You may need to continue to cover your eye for a while after your surgery.

The area may be a little sore after the procedure. But you should be able to take over-the-counter pain medicines as prescribed. Ask your eye care provider if you should not do certain activities while you recover, and find out for how long.

You will need close follow-up with your eye care provider to see if the surgery was effective. You may have an appointment the day after the procedure. Your eye care provider will need to make sure the new drainage opening is working well.

You will need continued follow-up care to watch how you are doing after your surgery. You may need to have stitches in your eye removed in a follow-up appointment. This will be a few weeks after your surgery. Seek medical care right away if you have bleeding, fever, worsening vision, increasing eye pain, or swelling.