Trabeculectomy (Glaucoma surgery)

Glaucoma is the name for a group of eye conditions which cause damage to the optic nerve. The normal fluid within the eye is unable to drain away properly which leads to a build up of pressure within the eye. The pressure is usually treated with eye drops. If the eye drops do not reduce pressure, damage to the optic nerve may cause permanent loss of sight. To lower the eye pressure a surgical procedure known as a trabeculectomy is performed.

Trabeculectomy procedure

A small opening is made in the white part of the eye under the upper eyelid to form a drainage channel. The opening allows the eye fluid to drain away to an area known as a filtering bleb. The bleb will have the appearance of a blister-like bump on the white of the eye, usually under the upper eyelid. An anti-scarring drug (Mitomycin C) is now conventially used to improve the success of the operation.

A trabeculectomy can take up to an hour and can be carried out either under a local or general anaesthetic. The doctor will discuss which option is most suited to you. After a successful trabeculectomy it may be possible to reduce glaucoma eye drops. If the trabeculectomy is not successful the operation may need to be repeated or further treatment may be required. The aim of the operation is to reduce the risk of further damage to the optic nerve. Surgery does not improve your sight, but will hopefully help protect your vision in the longer term.

What are the risks?

Some of the risks involved are:
• Bleeding
• Infection
• Inflammation
• For a period of time pressure in the eye may become too high or too low
• In some cases a cataract may develop. This can be treated by an operation if necessary.
• Serious complications are rare, but very occasionally the sight can get worse after the trabeculectomy and not recover.

Before the operation

If you are taking warfarin tablets please discuss the dose with the doctor.
Please take all other medication as normal or as instructed. Your doctor will advise you on which eye drops to use after surgery.

After the operation

• Your sight will often be blurred for a few days after the operation. This will usually improve after a week or two, but can last up to six weeks.
• Your eye will be watery and may be gritty for a week or two.
• Mild pain can be relieved by taking pain killers such as paracetemol.
• Post operative drops usually need to be taken every hour initially but the frequency will be explained to you by your doctor. If you are on more than one eye drop wait five minutes between applications of the different eye drops.
• In some cases you may require an injection to prevent scar tissue forming which can block the drainage channel. This can be given in the outpatient clinic.
• The stitches may also need to be adjusted or removed.
• Following the operation you should rest and take things easy but will be able to carry out normal day to day activities.
• Wear sun glasses if the light is too bright for comfort. If you wear contact lenses you should discuss this with your doctor. If you wear glasses your prescription may need to be changed following surgery, your doctor will advise you.
• You should not rub your eye, undertake strenuous exercise or heavy gardening.
• Avoid coughing / sneezing or straining as far as possible.
• Your surgeon will advise you when you will be able to drive and return to work.

If you experience any of the following:

• Severe pain
• Sudden loss of sight
• Discharge

then you need to contact your surgeon immediately.