What is trabeculectomy?

Trabeculectomy is a type of surgery done in the front part of your eye. It’s done to treat glaucoma by lowering the pressure in your eye.

The front part of your eye is full of fluid. (This is the area in front of the colored part of your eye, the iris.) Normally, this fluid slowly drains out of your eye through a network of channels, out into the veins of your body.

In glaucoma, fluid may pass too slowly out of this drain. This can cause the pressure in your eye to increase. This increases pressure on your optic nerve, which sends visual information to your brain. If the pressure increases too much, it can damage your optic nerve, causing vision loss.

During trabeculectomy, your surgeon makes a new opening for fluid to leave your eye. After numbing your eye, your surgeon removes a small piece of tissue from your eye. This allows the fluid to bypass the normal channel out of your eye. A flap of tissue from your sclera (the white part of your eye) and the conjunctiva (the thin layer covering your eye) partly cover this opening. This can help lower pressure inside the front part of your eye, which can help prevent future vision loss.

Why might I need a trabeculectomy?

You might need this procedure if you have glaucoma that you have not been able to control with eye drops or laser treatment. Without treatment, over time people with glaucoma lose their side (peripheral) vision. Over time, central vision may decrease too. This can cause a person to become totally blind.

Your eye doctor might advise trabeculectomy to help keep your glaucoma from getting worse. However, it does not restore vision loss that has already happened. Trabeculectomy is a possible treatment for both closed-angle and open-angle types of glaucoma. It is also a possible treatment for primary and secondary types of glaucoma.

Your eye doctor might want to try other treatments first before performing a trabeculectomy. For example, he or she may want to try medications to lower the pressure in the front of your eye. Another procedure, called laser trabeculoplasty, is also an option for some people. If these treatments don’t work, your doctor may recommend trabeculectomy. Surgical placement of a shunt is another potential surgery for some people.

Each of these treatment options has its own risks and benefits. Ask your doctor why trabeculectomy might make sense for you.

What are the risks of a trabeculectomy?

Many people do well with their trabeculectomy. However, complications from the surgery can sometimes occur. 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
  • Bleeding into the eye
  • Eye infections
  • Cataract
  • Low pressure inside the eye

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

Your risks may differ according to your age, your other health conditions, and the specific anatomy of your eye. Talk with your doctor about all your concerns and about the risks that apply to you.

How do I prepare for a trabeculectomy?

Talk to your doctor about how to prepare for your trabeculectomy. Ask whether you need to stop taking any medications before the procedure. You will need to avoid eating or drinking anything after midnight before the day of the surgery.

Your doctor may want certain tests before the procedure, to get a better idea of the anatomy involved. 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 doctor about what will happen during your trabeculectomy. An eye doctor (ophthalmologist) usually performs the surgery. In general, you can expect the following:

  • You may be awake during the surgery. You will receive a medication to help you relax. You may also receive an injection or a topical numbing medicine (anesthetic) to numb the area. This will keep you from feeling anything during the surgery.
  • In other cases, you may receive sleep medicine (anesthesia) to put you to sleep. If this is the case, you will sleep deeply through the surgery and won’t remember it afterwards.
  • You may receive an antifibrotic medication on your eye during and after the surgery. This can help reduce scarring and the chance for complications.
  • Your surgeon may rotate your eye during the surgery and temporarily secure it with a stitch.
  • Your surgeon will make an 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.
  • Your surgeon will make a small hole in your iris.
  • Your surgeon will close the area and remove the stitch that was rotating your eye.
  • You may receive antibiotics in your eye.
  • Your eye may be covered and taped shut.

What happens after a trabeculectomy?

Ask your doctor about what you should 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.

Be sure to follow your doctor’s instructions about caring for your eye. You may need to take antibiotics to help prevent infection. You may also need other medications, like 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 medications. Ask your doctor whether you should avoid any specific activities while you recover.

You will need close follow-up with your doctor to see whether the surgery was effective. You may have a scheduled appointment the day after the procedure. Your doctor will need to make sure the new drainage opening is functioning well.

You will need continued follow-up care to monitor how you are doing after your surgery. You may need to have stitches in your eye removed in a follow-up appointment a few weeks after your surgery. Be sure to tell your doctor right away if you have bleeding, fever, worsening vision, or increasing eye pain or swelling.

Next steps

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • The risks and benefits of the test or procedure
  • When and where you are to have the test or procedure and who will do it
  • When and how will you get the results
  • How much will you have to pay for the test or procedure