Good Hope, Heartlands, and Solihull Eye Clinics

Trabeculectomy

David Kinshuck

For patients

"trabeculectomy...surgery lowers eye pressure

the surgeon makes a tiny hole, and aqueous fluid then drains through the hole

Trabeculectomy is well described here, here , This page just has a few notes, with an animation here. Leaflet Trabeculectomy. Some wonderful videos and other information here. The pages above describe the operation, but there are important details to remember.

The operation creates a valve that leads fluid out of your eye. If this valve blocks as part of the healling process, anti-healing treatment to open the valve up is often needed. This will help to stop closing again. The anti-healing treatment often has to be repeated.

 

  • nearly all patients need antihealing treatment.
  • after the operation your sight may not be quite as clear, and there are risks as described on the pages with links above;
  • the operation is just the first stage; for instance
    1. the first day after your operation, if the pressure is very low, the steroid drops are stopped for a few days. For instance, if the 'AC' is deep, and the pressure 0, stop drops for 2 days (as an example).
    2. 1-2 weeks after the operation, if the pressure is >14mmHg, you usually need the releasable suture releasing
    3. a pressure of 10-14 is ideal at this stage (severe glaucoma needs a lower pressure)
    4. patients are often seen every week for a while to ensure the presure stays at this required level
    5. in the days after the operation patients with too much leakage and a shallow anterior chamber may need further surgery to seal the leak.
  • after the operation, steroid drops, antibiotic drops, and drops to dilate the pupil are often needed.
  • always bring the drops with you to the clinic, as the dose will be adjusted etc
  • in the weeks after the operation, if the wound becomes very red extra steroid drops may be needed (the redness is a sign of an over-active healing process)
  • if the pressure rises, anti-healing injections will be offered
  • you should not go on holiday abroad for 3 months after your operation (advice changes depending on how severe the glaucoma is, etc)
  • some ophthalmologists recommend no swimming after the operation in the years after surgery, but others feel swimming is safe once the eye has recovered after the operation (accepting there is a very small risk of problems, but that the benefits outweigh the risks.

For professionals

  • how to grade blebs
  • post-op red blebs need treatment (steroids, 5FU etc)...must get the bleb white
  • a small 'ring of steel' bleb has a much higher risk of infection...consider needling these
  • it is possible/helpful to needle old blebs, as long as they are not completely flat, 5FU will be needed for the procedure. 10mg in 0.4ml

Cataract surgery

  • Add 5FU 10mg in 0.4ml at the time of cataract surgery so the bleb will not block,
  • and may need post-cataract surgery steroid drops for 3 months.
  • the trabeculectomy may block Eye 15

For professionals post op, thoughts

1st day post op mitomycin trab

  • check iop
  • look at
    • bleb
    • AC
    • 2% fluorescein to see if bleb leaking
  • if leaking, reduce steroid drops

1st week

  • if > 14 and bleb flat and not leaking, gentle pressure behind bleb
  • check iop
  • look at
    • bleb
    • AC
    • 2% fluorescein to see if bleb leaking
  • if very red, increase steroid drops
  • if leaking, reduce steroid drops

2nd week

  • if > 14 and bleb flat and not leaking, gentle pressure behind bleb
  • check iop
  • look at
    • bleb
    • AC
    • 2% fluorescein to see if bleb leaking
  • if > 14 and bleb flat and not leaking, gentle pressure behind bleb
  • if very red, increase steroid drops
  • if leaking, reduce steroid drops

1 month

  • also remove INTERRUPTED sutures
  • releasable sutures only to be removed if IOP high