Trabeculectomy
Trabeculectomy
Author: Aashna Bhakkad
Purpose: Trabeculectomy is an outpatient eye surgery performed to lower intraocular pressure (IOP) in patients with glaucoma. It is typically recommended when medications, laser procedures like SLT, or other less invasive treatments fail to control eye pressure effectively. Trabeculectomy helps prevent further vision loss by improving fluid drainage from the eye.
When trabeculectomy is needed:
- You have open-angle glaucoma or angle-closure glaucoma
- Eye drops or laser surgery have not adequately controlled IOP
- You require a significant drop in eye pressure
- You prefer a non-implant-based surgical option
- You have no prior scarring of the conjunctiva from earlier surgeries
- Your doctor believes this is the best surgical option based on eye structure
Procedure:
Setting: Outpatient surgical center or hospital
Time: Around 45 to 60 minutes
Anesthesia: Local anesthesia with sedation
Goal: To create a new drainage route for aqueous humor, the fluid inside the eye
Steps
- The patient receives local anesthesia and a sterile drape is placed
- The surgeon creates a small flap in the white part of the eye (sclera)
- A tiny opening is made under this flap to allow fluid to drain
- The flap is sewn loosely to regulate the flow of fluid
- A small bubble (bleb) forms under the conjunctiva to collect the draining fluid
- Mitomycin C or 5-FU (anti-scarring agents) may be applied to reduce healing that could block the drainage
- The conjunctiva is closed over the bleb to complete the procedure
- The eye is covered and monitored post-operatively
- What to Expect After Surgery
- Vision may be blurry for several days or weeks
- Regular follow-up appointments are critical to monitor healing and IOP
- Eye drops (antibiotic and steroid) are usually prescribed to prevent infection and reduce inflammation
- You may need sutures removed or adjustments made in the clinic afterward
- Avoid rubbing the eye, bending over, or lifting heavy objects during recovery
- Most patients resume normal activities within 2–6 weeks, depending on healing
Risks of the Procedure
Trabeculectomy is generally safe, but possible complications include:
- Hypotony (eye pressure too low)
- Infection (blebitis or endophthalmitis)
- Scarring of the bleb, which can reduce surgical success
- Acceleration of cataract formation
- Bleeding inside the eye (choroidal hemorrhage)
- Vision loss in rare or severe cases
Benefits of the Procedure
- Long-lasting pressure control, especially when medications fail
- Reduces dependence on eye drops
- Can significantly slow or stop vision loss from glaucoma
- No need for foreign implants
Citations:
American Academy of Ophthalmology. Trabeculectomy: What to Expect. 15 Jan. 2021.
https://www.aao.org/eye-health/treatments/trabeculectomy.
Glaucoma Research Foundation. Trabeculectomy Surgery for Glaucoma.
https://glaucoma.org/trabeculectomy-surgery-for-glaucoma/.
National Eye Institute. Glaucoma Treatment. U.S. Department of Health and Human Services,
https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/glaucoma/glaucoma-treatment.
Kirwan, James F., et al. “Trabeculectomy in the 21st Century: A Multicenter Analysis.” Ophthalmology, vol. 120, no. 12, 2013, pp. 2532–2539.
https://doi.org/10.1016/j.ophtha.2013.05.024.
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