What Is a Trabeculectomy?
Trabeculectomy is a type of glaucoma surgery that involves operating on the eye to open a new passageway to drain fluid from the eye. This operation is done in the operating room as an outpatient procedure. By reducing eye pressure, it is used to stop glaucoma-related vision loss. A flap is made in the sclera, the white portion of the eye under the top eyelid, by the eye surgeon during trabeculectomy.
This flap creates a fluid flow route underneath it, reducing eye strain. The flap is lightly repositioned on the sclera to preserve the drainage channel. The conjunctiva, the eye's outermost layer, is then used to cover the whole surgical site.
A tiny fluid blister, known as a bleb, is produced due to this activity on the eye's surface but under the eyelid. The blister's liquid is absorbed by blood vessels and does not result in excessive tearing. Because the upper eyelid covers the bleb, it is typically invisible to others. The loss of eyesight is not reversed by trabeculectomy. The procedure's goal is to stop the progression of glaucoma-related visual loss.
What Are the Risks of a Trabeculectomy?
The majority of patients benefit from trabeculectomy.
However, surgical problems might occasionally occur. Risks consist of:
1. Failure of Surgery to Manage Eye Pressure: In most cases, scarring around the surgical site hinders proper fluid drainage inside the eye. If this occurs, the surgical site may occasionally be corrected by removing scar tissue, or another procedure may be carried out to relieve the eye pressure.
2. Fluid Leakage From the Surgical Site: This may occasionally go away on its own or call for further surgery to fix the leak.
3. Vision Impairment Due to Low Pressure: The ocular pressure may become excessively low if the trabeculectomy procedure results in excessive fluid outflow from within the eye. The trabeculectomy may need to be revised, or it may only be temporary.
4. Bleeding Inside the Eye: Trabeculectomy and low eye pressure can cause bleeding. Though extremely uncommon, this can result in eyesight loss.
5. Eye Infections: If not identified and treated right away, an infection at the operation site might spread to the eye and result in blindness.
6. Cataract: With aging, the lens inside the eye naturally becomes cloudy, referred to as a cataract. Although trabeculectomy is known to hasten the development of cataracts, surgery is a popular and extremely effective technique to manage this problem.
What Causes Glaucoma?
Aqueous humor is a transparent fluid that the back of the eye continually produces. The front of the eye is filled with this fluid. Then it exits the eye via channels in the cornea and iris. The intraocular pressure (IOP), the normal pressure in the eye, may rise if these pathways are closed or partially occluded. Intraocular pressure growth may cause injury to the visual nerve. Patients may lose their vision in one or both eyes as the nerve damage worsens.
The following are the causes that increase the pressure in the eyes:
-
Dilating eye drops.
-
Blocked or restricted drainage in the eye.
-
Medications, such as corticosteroids.
-
Poor or reduced blood flow to the optic nerve.
-
High or elevated blood pressure.
What Are the Postoperative Challenges After Trabeculectomy?
The following are the postoperative challenges after trabeculectomy:
1. Flat Bleb - Flat blebs will not succeed if they do not form during the first few days following surgery; if early scarring is the root of the problem, subconjunctival 5-FU injections or wound modification with ologen collagen matrix can block conjunctiva from sticking to the wound bed.
2. Bleb Leak - Leaking blebs can be corrected using an ologen collagen matrix or bandaged contacts for several days. Bleb leaks can result in flat blebs. Viscoelastic use in cataract surgery can frequently be utilized in the office to rebuild a flat anterior chamber to prevent corneal decompensation.
3. Flat Anterior Chamber - Viscoelastics used in cataract surgery may often be utilized to rebuild a flat anterior chamber at the slit lamp in the office to prevent corneal decompensation.
4. Blebitis - Blebitis, if contagious, can develop into the dangerous condition of endophthalmitis.
5. Suprachoroidal Hemorrhage - Long posterior ciliary artery rupture from gradual stretching and progressive serous choroidal separation is known as suprachoroidal hemorrhage. It often develops days after trabeculectomy and is accompanied by sharp pain frequently felt during straining.
6. Small Encapsulated Bleb - Subconjunctival MMC and lidocaine injections can swell the nearby conjunctiva, followed by a needle incision of the bleb side and bleb expansion. Alternatively, a biodegradable spacer or an ologen collagen matrix implant may be used in conjunction with this procedure.
What Is Postoperative Care After Trabeculectomy?
1. To increase aqueous humor flow to the bleb, glaucoma medicines are often stopped.
2. Typical topical treatments include antibacterial drops used four times a day and anti-inflammatory treatments, such as Prednisolone drops administered every two hours.
3. A shield is placed over the eye until the anesthesia that also anesthetizes the optic nerve wears off and vision returns.
4. Patients are told not to wipe their eyes for several days following surgery and to wear the shield at night.
Conclusion
The most commonly performed invasive glaucoma procedure is trabeculectomy. As evidenced by significant glaucoma, it is quite successful in treating advanced glaucoma. It is still possible to do a second trabeculectomy at a different location, even if the first failed. Anti-fibrotic and anti-inflammatory medications must be strengthened when doing the second treatment if scarring is the primary factor.
Intraocular pressure in the eye is decreased through trabeculectomy. This may delay or stop the loss of eyesight brought on by glaucoma. The doctor may suggest a trabeculectomy if typical glaucoma therapies like prescription eye drops or medication are ineffective in lowering intraocular pressure.
