Surgical Trabeculectomy or Glaucoma Filtration Surgery
Trabeculectomy or surgical trabeculectomy is the most commonly performed glaucoma filtration surgery world over. In recent years due to the availability of very effective eye drops the requirement of this surgery has reduced. However, sometimes when the pressure is not controlled with eye drops this glaucoma filtration surgery becomes necessary. Later in this article find out Glaucoma surgery cost in India.
What is Surgical trabeculectomy ?
In surgical trabeculectomy, sometimes also called Glaucoma filtration surgery, a connection planned from the inside part of the eye where the IOP (intraocular pressure) is high to the outside part of the eye where the IOP is low.
This planned connection is by removing a 2×2 mm window of the sclera (white part of the eye) and then covering the open window with conjunctiva (the clear membrane that lies over the entire eyeball). The fluid now flows from the inside of the eye drains into a space under the conjunctiva.
As the fluid flows through the new drainage opening, the tissue over the opening rises to form a little blister or bubble, called a bleb. The bleb is located where the sclera, or white of the eye, joins the iris, the colored part of the eye. You could read more about glaucoma surgery.
The entire surgery takes place under local anesthesia.
Who should undergo Surgical Trabeculectomy ?
Patients who have advanced optic nerve damage as detected on the OCT.
Those patients who have advanced visual field loss as detected on the visual field test.
Glaucoma patients who are on maximum medical treatment but still have raised eye pressure.
Patients who want to be free from putting drops lifelong due to side effects or general burden on their quality of life.
What are the pre surgery requirements?
Patients should have normal blood sugars and normal blood pressure. Any abnormality in these values will hamper the healing post operatively.
Eye pressure should not be very high. Oral medications to bring down the pressure of the eye given to patients with very high eye pressure. Operating on an eye with very high pressure can cause problems like bleeding and tissue damage during the surgery.
What to expect after glaucoma surgery?
After glaucoma surgery or surgical trabeculectomy it is important that the patient comes for follow up every 2 days for the 1st week. This is important because this is the crucial period during which the connection made in the eye heals and most of the glaucoma surgery side effects felt in this period .
The doctor will check if the pressure inside the eye is not too high or not too low and accordingly alter the management in the first 2 weeks.
Sometimes an injection in the eye gets decided after surgery to keep the connection open if the doctor feels it is getting blocked due to the natural healing process of the eye.
What are the side effects of glaucoma surgery?
As mentioned before, it is very common that after a glaucoma surgery, till the connection between the inside and outside of the eye heals fully, the pressure inside the eye fluctuates. Hence it is very important that the patient follows up closely with us.
Sometimes the intraocular pressure becomes too low in which case a patch placed over the eye for a few hours. It may also be too high post surgery in which case simple medications, or removal of a suture in the OPD itself can help tide over this temporary effect.
Patients may complain of pain and irritation in the eye post operatively but they are temporary side effects and go in a week or so.
In patients who have a mild or early stage cataract the cataract advances faster after a glaucoma surgery. We advise patients with early grade cataracts to get a combined procedure. Doing a cataract surgery later may result in failure of the glaucoma surgery.
One of the more serious complications is eye infections. These infections can happen after any eye surgery and even after a trabeculectomy. Patients should know that if there is pain or redness or decreased vision after the surgery they should immediately consult their eye surgeon or glaucoma specialist.
In the long term, maybe 3-10 years later, the surgery can fail. Which means that it stops helping in reducing pressure. If that happens and pressures begin to rise again then one may have to perform the surgery again.
What to expect after glaucoma surgery ?
STRICT HYGIENE. It is very important and stressed more that maintaining strict cleanliness around the eye is extremely important. Just as now there is a connection for fluid to exit the eye there is also a connection for bacteria to get into the eye. If that does occur the consequences are very troublesome.
Proper application of medications as advised by the doctor. Appropriate application of medication ensures no infections and also helps in the healing process. This in turn ensures normal pressures inside the eyeball
Avoid any physical activity that causes a lot of pressure on the upper part of the body. This causes undue pressure on the eyeball and may cause excess fluid to drain out of the eyeball.
No water should go into the eye for a period of 2 weeks. Its advised to have a bath from the neck below, avoid swimming, avoid stepping out of the house in the rain.
Who performs the glaucoma surgery ?
At Eye solutions we have a glaucoma dept and have one of the best glaucoma specialist in the city of Mumbai. All glaucoma procedures assessed under only by the glaucoma specialist.
Frequently Asked Questions
A trabeculectomy advised for a few different reasons. Sometimes we use chemicals on the surface of the eye to prevent the natural process of eye healing. Thus depending on what is use the charges vary. However to be able to give you an idea we charge between Rs 30000 – 55000 for a Trabeculectomy
A trabeculectomy reduces the eye pressure of the eye. It prevents the eye pressure from increasing. In turn prevents further damage to the optic nerve. However it is unpredictable how the eye heals over time. There are instances where the pressure starts to rise again after 5-10 years. In those cases it can be easily managed with one or two drops which would then control the eye pressure. So Glaucoma is not reversed but the pressure gets reduced.
No. This surgery motive is to make the patient’s eye pressure normal without the use of eye drops. However if the pressure is high in the immediate post op period it may be necessary to use drops for a few days.
Also as mentioned earlier if over the years the pressure again rises then drops becomes necessary.
It equalises the pressure between the inside of the eye and the outside so that the pressure inside the eye which was high earlier becomes normal.
We recommend gently dabbing the eyes with a sterile swab or cotton soaked in distilled water. Throw away the swab after single use . We do not recommend tissue paper, handkerchiefs or towels to clean the eyes.
- This surgery is required in patients whose glaucoma or eye pressure is not controlled with medications.
- When a patients iop is in control under medications but is in end stage glaucoma where there is severe damage to the optic nerve and it is not stable we advocate doing the surgery for better control.
Initially in the 1 st week every 2-3 days. After the initial healing period is over and the pressure has stabilised once a month for around 6 months. After 6 months the frequency will reduce as per the condition of the eye.
- Strict cleanliness, no touching the eyes, water should not enter the eyes and only using sterile cotton to clean the eyes.
- No applying pressure to the eyes as this can bring the eyes pressure very low which will affect the other structures in the eye
- Using medictaions as advised by the doctor
Post surgery it is important that the patient comes for follow up every 2 days for the 1 st week as this is the crucial period during which the connection made in the eye heals.
The doctor will check if the pressure inside the eye is not too high or not too low and accordingly alter the managment post op.
Sometimes an injection in the eye becomes advisable post op to keep the connection open if the doctor feels it is getting blocked due to the healing process.
This surgery is to make sure that the part of the optic nerve that is not affected by the raised pressure doesnt get damaged further.It is a surgery that preserves vision rather than improves it.
Unfortunately the part that has already affected is permanent as nerves once damaged cannot revive.