When medications and laser surgery have been inadequate to control glaucoma, and progression of the disease with further loss of vision is inevitable, surgery is the next step. Also called glaucoma filtration surgery, trabeculectomy is sometimes performed before other modalities of treatment based upon the type of glaucoma and how advanced it may be.
Trabeculectomy surgery is sometimes combined with a cataract operation when both conditions coexist.
The procedure is performed in an operating room under local anesthesia. When the patient is brought to the operating room, the eye is cleaned and sterilized, and the proper drapes are placed on the eye. The patient will be comfortable however, since a mild form of sedation is used and there will be minimal pain if at all.
The goal of the glaucoma filtration procedure is to create a new drainage system with the tissues of the eye so that aqueous fluid (fluid produced in the front part of the eye) may drain out of the eye and lower the intraocular pressure. Sometimes a small tube is inserted in order to control the flow of fluid from inside the eye to the outside. Fluid ultimately is drained to underneath the conjunctiva which is the outermost layer covering the eye, and a”bleb” is formed. The fluid is ultimately absorbed by the blood vessels and tissues of the eye.
In most cases, an antifibrotic agent such as Mitocycin C and 5-Fluorouracil will be used to help control excess scaring which is the most common cause for the surgery to fail.
After the surgery, drops will be used for several weeks in order to help with the healing process. Follow-up visits with the doctor may be very frequent after surgery depending on the healing process.
It is important to know that glaucoma is rarely cured but rather controlled. Good control means that the disease is not progressing and no further damage will occur. Glaucoma filtering surgery has a very effective way of achieving control.