Trabeculectomy Surgery for Glaucoma

Trabeculectomy is a commonly performed glaucoma surgery worldwide. This procedure creates a new pathway for fluid to drain out of the eye, hence reducing eye pressure.

In this surgery, the eye surgeon makes an incision in the conjunctiva, the outermost layer covering the white part of the eye. A small flap is created in the sclera, which is the white outer wall of the eye. A small piece of tissue under the flap is removed which allows fluid from inside the eye to flow out. The flap is then placed back down and stitched. This protects against too much fluid from draining, which will cause the eye pressure to be too low.

Points to note about the procedure: 

• Those on blood thinners need to stop them before surgery.
• It is a day surgery procedure.
• Numbing injections will be given.
• Stitches may be removed a few weeks after surgery.
• You will be prescribed antibiotics and steroid eye drops to prevent infection and scarring. 
• Do not swim for 3-4 weeks after the surgery. 
• Avoid exertion for 3-4 weeks after the surgery. 
• Cover the eye with a shield for when you sleep for a few weeks after the surgery. 

Complications of a Trabeculectomy

While trabeculectomy is one of the most effective glaucoma surgeries for lowering eye pressure, results can vary between individuals.

Potential complications of trabeculectomy include:

• Leakage of fluid from the bleb or the conjunctiva
• Low eye pressure
• Bleeding inside the eye
• Cataract
• Droopy eyelids
• Dry eyes or eye discomfort
• Loss of vision
• Eye infections.

The tissue over the bleb can be very thin, making it susceptible to infections. Hence, trabeculectomy is usually offered to those with advanced glaucoma.  It is also possible that scarring around the surgery site prevents fluid from draining well. This increases eye pressure again, and if left untreated, the glaucoma will get worse. Failure of trabeculectomy from scarring is more common in those who have been using glaucoma eye drops for many years, whose eyes are inflamed and red before trabeculectomy, and those with an aggressive skin scarring response. A procedure to break the scar tissue can be performed, or different glaucoma surgery may be required.