Trabeculectomy Surgery for Glaucoma

8 sources cited
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What is a Trabeculectomy?

A trabeculectomy is a type of surgery for glaucoma. The surgery aims to lower intraocular pressure in the eye caused by glaucoma. It is necessary if glaucoma medications and laser surgery do not successfully lower eye pressure. 

The eye is filled with a continuously flowing fluid called aqueous humor, which provides nutrients to the eye. It is also responsible for maintaining constant intraocular pressure. 

The aqueous humor flows through a drainage system called the trabecular meshwork, a spongy tissue next to the cornea. If the trabecular meshwork is blocked, eye pressure becomes too high, causing damage to the optic nerve. This condition is called glaucoma and can lead to blindness if left untreated.

While trabeculectomy surgery, also called glaucoma filtration surgery, effectively reduces eye pressure, it does not cure or reverse vision loss.

Trabeculectomy surgery is usually performed in an outpatient clinic, so you can return home the same day.

Who Needs a Trabeculectomy?

An eye doctor recommends a trabeculectomy when other glaucoma treatment options, such as medication or laser surgery, fail to lower intraocular pressure.  

It is a common treatment option for open-angle glaucoma. However, it may be necessary for other types of glaucoma, including acute-angle closure glaucoma and secondary glaucoma.

Cost

Depending on the complexity of the surgery, the cost of a trabeculectomy can range from $1,000 to $11,000.

Health insurance typically covers a portion of glaucoma treatment, including trabeculectomy surgery, as long as it is medically necessary. Check with your insurance company to confirm which treatments and procedures your plan covers.

Trabeculectomy Procedure: What to Expect

Most trabeculectomy procedures take place in an outpatient setting, allowing people to go home the same day. The duration of surgery ranges from 30 to 90 minutes

Your eye doctor will give you instructions to help prepare for surgery. These instructions include a time to stop eating and drinking, among other protocols. If you don’t follow the instructions closely, your doctor might cancel the surgery for safety reasons.

Preparing for Surgery

Educating yourself about glaucoma will help you prepare for the surgery. Also, confirm what your insurance plan covers to avoid surprise charges and copayments.

A few helpful questions to ask your eye doctor before surgery include:

  • Do I need to stop taking any daily medications or supplements before surgery?
  • Do I need to fast (not eat or drink anything) before surgery?
  • Will I be receiving conscious sedation or general anesthesia?
  • How long does recovery take?
  • Do I need someone to take care of me after surgery?
  • How will I know if the surgery was successful?

If the trabeculectomy is taking place in an outpatient clinic, make sure you have a designated driver to take you home. Remove any makeup, leave your contact lenses at home, and wear comfortable clothing and shoes.

During Surgery

Conscious sedation (awake) and general anesthesia (asleep) are both administered intravenously (IV). An IV allows the healthcare professional to administer the medication quickly and effectively. 

Your vitals (heart rate, breathing rate, and blood pressure) are closely monitored while receiving anesthesia. Medicated eye drops will also be used to numb the eye(s).

During trabeculectomy surgery, the eye doctor will use small tools and a microscope to create a small hole in the upper area of the eye. 

A flap is created in the sclera (white of the eye) to cover the hole controlling the flow of aqueous humor into a bleb (reservoir). Also called a partial thickness scleral flap, it is located beneath the upper eyelid and is not noticeable after surgery. The fluid will then be reabsorbed by the body, lowering eye pressure back down to a normal level. 

After Surgery

After glaucoma surgery, you’ll wear a shield that covers your eye and promotes healing. You will be monitored in a separate room until you are awake and able to stand on your own. 

Here’s what to expect after a trabeculectomy:

  • Your eyes may be red and irritated (avoid rubbing them to avoid damage)
  • You will wear an eye patch or shield at night
  • Recovery can take 4 to 6 weeks
  • Frequent follow-up visits will occur to monitor eye drainage
  • Avoid lifting, bending, and vigorous exercise
  • Vision may be blurry for up to 6 weeks
  • Avoid wearing contact lenses and eye makeup while your eye heals
  • Avoid swimming, gardening, and dusting for 2 weeks
  • Your doctor will tell you when you can drive again

Your doctor will prescribe steroid eye drops and other medications to prevent infection, reduce inflammation, and minimize scarring of the bleb (fluid reservoir). You should use these daily or as directed by your doctor. 

What are the Risks of a Trabeculectomy?

Glaucoma surgery is not recommended for everyone because there are risks involved. Unlike cataract surgery, it is not meant to restore vision. It only slows the progression of vision loss. 

There are risks to consider during surgery, after surgery, and once the eye heals:

  • Bleeding during surgery
  • Eye pressure is too low
  • Eye pressure remains too high
  • Delayed bleeding after surgery
  • Failing bleb caused by scar tissue
  • Bleeding in the retina, also called decompression retinopathy

During the healing process, the body’s natural defense is to create scar tissue over the bleb, which can lead to a failing bleb. The eye doctor applies an antimetabolite, which is a substance that inhibits certain functions of a cell, called mitomycin (MMC) to the eye tissue to prevent bleb scarring. 

In 5% of cases, MMC can cause a bleb leak, another risk of glaucoma surgery. A leak can happen right after surgery or months after the eye heals. It is associated with decreased eye pressure (hypotony) and risk for infection (endophthalmitis).5 

Trabeculectomy Outlook & Success Rates 

Trabeculectomy surgery is an effective procedure for reducing intraocular pressure and preserving vision.

The long-term success rate of trabeculectomy is close to 90%. Many of these patients are able to stop taking glaucoma medications since their eye pressure stays controlled after surgery. Glaucoma surgery is also effective at stabilizing visual acuity (distance vision).7

With the timely follow-up and close monitoring by an eye doctor, the trabeculectomy outcome is good.

Alternative Treatment Options

Glaucoma treatments include medication, laser therapy, and surgery. While research is ongoing, there is no supporting data recommending any alternative treatment options. 

The most effective way to prevent glaucoma is to:

  • Follow your eye doctor’s directions 
  • Maintain a healthy diet
  • Exercise regularly
  • Get enough sleep
  • Quit smoking

Summary

Trabeculectomy surgery treats various types of glaucoma. Glaucoma develops when the eye's intraocular pressure becomes too high and causes damage to the optic nerve. If not treated, glaucoma can cause blindness.

Trabeculectomy surgery aims to lower the intraocular eye pressure by making a small hole in the upper eye area, followed by a scleral flap to cover the gap. This allows controlled flow of the aqueous humor (fluid), which brings down eye pressure. 

Trabeculectomy is an outpatient surgery that takes 30 to 90 minutes. You will need a driver to take you home.

Recovery takes 4 to 6 weeks. You will need to administer daily eye drops to prevent infection and reduce swelling. Also, avoid swimming, gardening, and vigorous exercise until your eye heals.

8 Cited Research Articles
  1. Glaucoma surgery series: Trabeculectomy.” BrightFocus Foundation.
  2. How much does glaucoma treatment cost? Cost Helper.
  3. What is a trabeculectomy?” MyHealth.Alberta.ca.
  4. Risks of trabeculectomy (Part 1 of 2).” New Glaucoma Treatments.
  5. What is the big deal about a bleb?” New Glaucoma Treatments.
  6. Surgically Revising Bleb Leaks After Trabeculectomy.” Glaucoma Today.
  7. Mutsch, Y. “Success criteria and success rates in trabeculectomy with and without intraoperative antimetabolites using intensified postoperative care (IPC).” Graefes Arch Clin Exp Ophthalmol, Ltd. Nov. 2000
  8. Alternative Therapies for Glaucoma.” Glaucoma Research Foundation.
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