Trabeculectomy

What is trabeculectomy?

Trabeculectomy in Tunisia is an ophthalmologic surgical procedure that involves removing all or part of the trabeculum. The procedure, performed by an ophthalmologic surgeon in a modern and fully equipped setting, will notably treat IOP (intraocular pressure) and preserve the patient’s eye’s visual abilities. Here is what you need to know about this intervention: its principle, its course and its aftermath.

Who is trabeculectomy for?

Trabeculectomy is a surgical procedure primarily intended for patients with glaucoma, an eye disease that causes an increase in intraocular pressure that can damage the optic nerve and lead to vision loss. This procedure is generally recommended when medical treatments or laser therapies have failed to effectively control intraocular pressure. It is therefore intended for patients with open-angle or closed-angle glaucoma, as well as those suffering from secondary glaucoma related to other medical conditions. Trabeculectomy may also be considered for individuals with a family history of glaucoma or those who present high risk factors. In short, this procedure is intended for patients whose condition requires more aggressive management to preserve their vision and improve their quality of life.

How does the trabeculectomy technique work?

Eye trabeculectomy is an operation performed as a treatment for intraocular pressure. When eye drop treatment and laser surgery do not yield the expected results, then this surgical solution may be considered by the ophthalmologist. The aim of the operation will be to create a protected fistula to promote the outflow of the aqueous humor present in the anterior chamber (which is at the origin of the pressure). Today, trabeculectomy is one of the most commonly considered treatments for open-angle glaucoma. The operation can yield satisfactory results, but it must be kept in mind that it also carries some risks for the patient’s eye.

What is the price of a trabeculectomy in Tunisia?

For your trabeculectomy operation in Tunisia, Tunisia Destination Santé offers very advantageous rates. The packages we offer include the fees for your operation in an ultra-modern clinic, post-operative care, and your accommodation in a luxury room. For more information on our prices or to request a quote, please do not hesitate to call us or fill out our online form.

When to perform a trabeculectomy or a sclerotomy?

The decision to perform a trabeculectomy or a sclerotomy is often made based on the severity and progression of glaucoma, an eye disease characterized by an increase in intraocular pressure. These surgical interventions are generally considered when other treatments, such as medications or laser procedures, fail to effectively control intraocular pressure or slow the progression of the disease. Trabeculectomy, consisting of creating a new outflow pathway for intraocular fluid, is often recommended when intraocular pressure remains high despite maximal medical treatment. On the other hand, sclerotomy, which involves opening an outflow pathway through the sclera, may be considered as an alternative, especially if trabeculectomy is not suitable for the patient. The optimal time for these interventions depends on the individual assessment of each patient by an ophthalmologist. As a general rule, they are considered when glaucoma presents a significant risk of vision loss, and the decision is made after a thorough analysis of medical history, ocular examination results, and responses to previous treatments. Open dialogue with a healthcare professional will help determine the best surgical approach based on the specific needs of each individual.

What you need to know before the procedure

This procedure is most often performed in patients aged between 20 and 65 years, with the average age of patients most often between 48 and 50 years. Before the operation, the patient will have to undergo a check-up for endo-ocular inflammation and follow an anti-inflammatory treatment. It is only after approximately 12 weeks of the first check-up that they will have the possibility of going to the operating table. As with every surgical operation, you will need to prepare a complete medical file before undergoing the procedure. In particular, you will need to have ophthalmological examinations, a complete health check-up and blood tests. You must not have symptoms or illnesses that may contraindicate the operation.

How is a trabeculectomy performed?

The operation is most often performed under local anesthesia, but general anesthesia trabeculectomy may be considered in the case of severe IOP. The surgeon begins by making a conjunctival incision, which will allow them to have a good filtration bubble. Once the incision is made, the surgeon creates a flap in the sclera, and a hole will be drilled to reach the inner chamber. In this way, the aqueous humor, which is at the origin of the increase in eye pressure, will be evacuated from the inner chamber. The surgeon concludes the operation by applying stitches to close the scleral flap. The conjunctival incision is also closed with stitches.

What are the post-operative consequences of a trabeculectomy?

As with any other surgical operation, trabeculectomy carries some risks for the patient; you will need to discuss possible complications with your surgeon before going to the operating table. One of the possible complications that can occur after the procedure is the appearance of a cataract in the operated eye. Other complications are possible, such as inflammation in the eye, or even hypotony of the eyes. However, when the operation is successful, the patient benefits from a satisfactory decrease in the level of ocular pressure in the operated eye. In the event that the operation is unsuccessful, it is possible to consider a return to the clinic for a second operation. After the intervention, you must scrupulously follow the surgeon’s recommendations so that the convalescence phase takes place without complications.

Success factor: scar tissue management

Scar tissue management is crucial in the context of trabeculectomy, a surgical procedure often used to treat glaucoma. After the creation of a filtering fistula aimed at improving the drainage of intraocular fluid, scar tissue must be carefully managed to prevent premature closure of this newly created pathway. Surgeons may use antimetabolic agents, such as 5-fluorouracil or mitomycin C, to modulate scar tissue formation and prevent excessive scar tissue formation. Close post-operative follow-up allows monitoring of scar tissue evolution and adjustment of treatment as needed. Effective scar tissue management in the context of trabeculectomy is therefore a key success factor, contributing to maintaining controlled intraocular pressure and preventing recurrence of glaucoma symptoms.

What are the potential risks and complications associated with trabeculectomy?

Trabeculectomy, although a common and effective procedure for treating glaucoma, is not without risks and complications. Potential risks include eye bleeding, infections, and adverse reactions to medications used during and after the operation. Post-operative elevation of intraocular pressure, called hypertensive peak, can also occur and requires careful monitoring. A complication specific to trabeculectomy is excessive fibrosis at the level of the filtering fistula, which can lead to premature closure. To counteract this, antimetabolic agents such as 5-fluorouracil or mitomycin C are often used to modulate scar tissue. Cataracts can also develop as a secondary complication of trabeculectomy, due to the changes induced by the surgical intervention in the eye. Patients should be informed of these potential risks, and healthcare professionals implement preventive strategies, as well as regular post-operative monitoring, to minimize these complications.

What are the side effects of trabeculectomy?

Trabeculectomy, while a common and generally effective procedure for treating glaucoma, can lead to some side effects. Potential complications include infection, which can occur at the surgical site and require antibiotic treatment. Bleeding can also occur, leading to blood accumulation in the eye (hyphema) or excessively low intraocular pressure. In addition, some patients may experience post-operative eye pain or discomfort. Abnormal scar tissue can also affect the success of the procedure, leading to persistently high intraocular pressure. In rare cases, more serious side effects such as vision loss or retinal detachments can occur. It is essential that patients discuss these risks with their ophthalmologist before undergoing the procedure, in order to better understand the benefits and drawbacks of trabeculectomy in their particular situation.

What are the expected results after a trabeculectomy?

Following the procedure, a 25 to 35% decrease in ocular tension is observed, and in some cases, it is even possible to observe a 45% reduction in ocular pressure. The number of anti-glaucoma molecules can be reduced by up to 60%, which is a satisfactory result for this type of intervention. With good inflammation control, and without the presence of certain risk factors, the patient can benefit from an adequate result and a fairly good reduction in ocular pressure. For all these reasons, this technique represents a good solution for treating glaucoma today.

Your ophthalmologic surgery in Tunisia with TDS

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