The risks of trabeculectomy include infection, bleeding in the eye, reduced or loss of vision, low eye pressure, failure due to scarring, precipitation of cataract, droopy eyelid. During the preoperative consultation we will discuss in detail all the benefits and risks of the procedure, including all alternative options, so you can make an informed decision.
This varies according to the complexity of the case. I create a for plan surgery and post operative follow for every patient individually.
It usually takes approximately one hour, or a bit longer if it is performed under general anaesthesia.
During surgery your eye will be numb, so you should not experience any pain. After surgery there might be some discomfort which should settle with the drops you will be asked to put in your eyes.
Occasionally the superficial sutures may be the cause of this. They are easily removed in the clinic during a follow-up visit.
The sutures used in trabeculectomy do not dissolve and only some of them may need to be removed. This is tailored to every individual and I will advise you accordingly.
It is expected that after the operation your vision may decrease for a few weeks. It should gradually come back to the same level as before the surgery. Sometimes you may need to change your glasses when your vision becomes stable. Please note that trabeculectomy will not improve your vision or restore any field of vision you have already lost due to glaucoma.
You should continue with your normal drops even on the day of surgery, unless I advise otherwise. After the procedure, you will receive a leaflet and clear instructions about the drops you need to use.
Indeed, you can have trabeculectomy. Depending on the type of medication you take, I will advise you further.
Mitomycin C is a chemotherapy drug that is used in cancer to stop the production of new tissue. In glaucoma surgery it is used to reduce scarring. Scarring causes failure of the trabeculectomy as the fluid cannot flow out of the eye. During the surgery, Mitomycin C may be applied to the surface of the eye for about 3 minutes. The Mitomycin C is then washed away from the eye with sterile water so that there is no drug left in the eye.
Cataract formation is a natural process of ageing but can be accelerated by trabeculectomy. The cataract surgery after trabeculectomy is more complex and there is a higher risk of trabeculectomy failure after it. In expert hands though, it can be managed very well. Your vision will be restored and the trabeculectomy will remain functional.
If the eye pressure rises due to scarring, a procedure called “needling” can be performed to unblock the scarring and get the trabeculectomy functioning again. In rare cases, if needling fails, another trabeculectomy can be performed, or a tube can be implanted.
Research has shown that it is advisable to have the procedures separately, as the inflammation caused by the cataract surgery can cause the trabeculectomy to fail. I will be able to recommend which procedure should be done first. If cataract is of priority, I can combine it with the iStent, so you may not require the tabeculectomy eventually.
The first month after the surgery is critical, to get the flow of fluid right. As a rule, you could expect to attend once a week. After that it is usually once a month for 3 months and then back to normal follow up. Obviously this varies according to the individual.
You will need to remain at least 2 weeks off work. Your return to work will depend on a number of factors such as the nature of your job, and the level of vision in the other eye.