Trabeculectomy: Post-operative Care

What is a Trabeculectomy?

Trabeculectomy is a surgical procedure used to treat glaucoma by lowering the pressure inside the eye. This procedure is considered when medical treatments or laser surgery are insufficient to reduce intraocular pressure.

Trabeculectomy is a very delicate operation. For a successful operation, it is essential to have an operating room, to perform a local anesthesia of the eye to be treated, to have a qualified anesthesiologist, and to allow approximately one hour for the intervention. These interventions have a success rate of between 60% and 80% in controlling intraocular pressure over a five-year period.

After a trabeculectomy, patients generally stop taking the medications prescribed to treat their glaucoma. They then begin treatment with antibiotic and steroid eye drops to prevent infection and control inflammation. When successful, this procedure is particularly effective in lowering intraocular pressure. This is why it is considered one of the leading interventions for patients with advanced glaucoma.

 

Your Recovery After Trabeculectomy

After trabeculectomy surgery, your eye may be red and irritated. It may also water more than usual or swell slightly. Even if your eye is uncomfortable, it is important not to rub it. Rubbing your eye could damage it.

You will likely be able to return to work or your usual routine one to two weeks after the operation.

For a few weeks, you may need to see your doctor several times a week. This is necessary to check if your eye's healing process is progressing as expected.

Your vision may be blurry for up to 6 weeks after the operation. As this improves, your vision will likely be as good as it was before the operation. However, you may need to change your glasses or contact lenses. Some types of glasses and contact lenses may be better suited to your eye after trabeculectomy.

If necessary, your doctor will recommend or prescribe pain medication. They will also give you eye drops and may prescribe medication.

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How to Behave at Home After a Trabeculectomy?

Good Practices After a Trabeculectomy

  • Rest when you feel tired. Getting enough sleep will help you recover;
  • Wear your glasses during the day. Wear your eye shield or patch at night for a week or as long as your doctor requests;
  • Ask your doctor when it is permissible to resume driving;
  • You can read or watch television;
  • Do not wear contact lenses for about 8 weeks, or until your doctor tells you it's possible;
  • Do not wear eye makeup for 2 weeks. You should also avoid face creams or lotions;
  • After the operation, it is possible to shower or wash your hair the following day. However, it is best to avoid any contact with water, soap, shampoo, hairspray, or shaving cream around your eyes, especially during the first week.
  • Do not rub or put pressure on your eye for at least a week;
  • Avoid hair coloring for 10 days after the operation;
  • Do not bend over and do not do strenuous activities, such as cycling, jogging, or aerobics, for two weeks or until your doctor tells you that you can do so;
  • Avoid swimming and gardening for one to two weeks;
  • Wear sunglasses if your eyes are sensitive to light;

Medication After Trabeculectomy

Your doctor will tell you if and when you can take your medication after your trabeculectomy. They will also give you instructions on taking any new medication.

  • If you take aspirin or another medication with anti-coagulant effects, feel free to consult your doctor about when you can resume its use. Be sure to understand your doctor's instructions to properly follow their treatment.
  • Follow your doctor's instructions on when to use eye drops. Always wash your hands before putting in your drops. Putting in eye drops:
        • Tilt your head back and pull your lower eyelid down with a finger;
        • Drop or squirt the medication inside the lower eyelid;
        • Close your eye for 30 to 60 seconds to allow the drops to move and reach the entire surface of the eye;
        • Do not touch the tip of the dropper with your eyelashes or any other surface;
        • Follow your doctor's instructions for taking pain medication;
        • As your eye recovers, your doctor will assess the need to continue your glaucoma treatment. You may no longer need medication, or the dosage may be reduced. If your doctor deems it necessary to maintain treatment, be sure to carefully follow their instructions for taking it.
        • If you have constipation, your doctor may suggest taking laxatives.

      These medications help you avoid straining when trying to evacuate your bowels. Straining can increase pressure in your eye;

 

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When to Contact Your Doctor or Emergency Services After Trabeculectomy?

Call your doctor, contact emergency services, or seek immediate medical attention if:

  • You experience symptoms of an eye infection, such as:
    • Pus or thick discharge from the eye;
    • Redness or swelling around the eye;
    • A fever;
  • You have new or worsening eye pain;
  • You have vision changes;
  • If you have signs of a blood clot in your leg, called deep vein thrombosis, they may include:
    • If you experience pain in your calf, back of your knee, thigh, or groin, consider this information:
    • Redness and swelling of your leg or groin;

Trabeculectomy Success Rate

Trabeculectomy involves an incision in the sclera, or white part of the eye, to create a small flap. Then, the surgeon will create a small bubble or pocket in the conjunctiva, which is the clear covering over your sclera. This bubble is called a filtration bleb.

Generally, the bleb hides under your eyelid so that it is not seen when someone looks at you. This new pocket allows the aqueous humor to drain from your eye at a healthier rate. Once this fluid is in the bleb, it will be absorbed by the surrounding tissues, so it will not increase the fluid pressure in your eye.

Invasive surgical procedures like trabeculectomy are reserved as a second-line treatment. However, they can be used as a first-line treatment if you have acute glaucoma that threatens your vision. If eye drops or laser procedures don't work well enough to reduce fluid pressure in your eyes, your ophthalmologist will evaluate you and determine if trabeculectomy is the right procedure for your eye health.

Long-term studies show that trabeculectomy, when necessary, is a fantastic treatment for glaucoma. It often eliminates the need for prescription eye drops, which can be expensive. While it is a more invasive operation, medical studies show that it is often more successful at maintaining low intraocular pressure compared to medication and laser operations.

In a 20-year study, 90% of participants who underwent trabeculectomy reported that their fluid pressure was still in a healthy range. Two-thirds did not need medication, while one-third still needed prescription eye drops to manage intraocular pressure.

 

What Should I Expect After Glaucoma Surgery?

Even if the surgery is able to lower intraocular pressure and keep your vision stable over the long term, your doctors will need to continue to carefully monitor your glaucoma during this time. It is important to understand that glaucoma surgery does not usually improve or restore vision that has already been lost. The surgical technique prevents future vision loss due to glaucoma.

 

FAQ trabeculectomie

 

Success Factors of Trabeculectomy

The success of trabeculectomy depends heavily on the surgery itself. However, frequent follow-ups for medication and scar/bleb management can improve success rates. In addition to anti-scarring medications, your doctor may suggest alternative medications during your clinic visits.

For example, depending on the stage of scar formation, your ophthalmologist may decide to partially suture the flap. During your clinic visits, the sutures will be released from time to time using a laser to promote better fluid outflow.

It is interesting to note that the rate of patients requiring a new surgical intervention after trabeculectomy varies between 10 and 12%. Studies also indicate that 20% of these procedures do not control intraocular pressure for more than 12 months, and 2% fail each year after that period.

Patients with the highest risk of failure are those who wear artificial lenses or whose bleb encapsulates.

 

Glaucoma and Symptoms

Glaucoma is an eye disease that can lead to progressive deterioration of the optic nerve, causing irreversible vision loss if not treated in time. Symptoms can vary depending on the type and severity of the disease. Although in its initial stages, glaucoma may be asymptomatic, it can eventually manifest with various signs.

Glaucoma often manifests with symptoms such as blurred or degraded vision, halos around lights, side vision loss, eye pain, headaches, and impaired central vision. People with this disease may also suffer from tunnel vision, where central vision is intact but side vision is limited.

There are different forms of glaucoma, including open-angle glaucoma, closed-angle glaucoma, and congenital glaucoma. Open-angle glaucoma is the most common and develops gradually without causing pain or other apparent symptoms. In contrast, closed-angle glaucoma can cause severe and sudden pain, nausea, and vomiting.

Several factors need to be considered to assess the risk of developing glaucoma, including age, family history, intraocular pressure, ethnicity, and eye injuries. People of African or Latin American descent are more likely to develop this disease, and diabetes is also a factor to watch for.

To prevent permanent vision loss due to glaucoma, it is recommended to regularly consult an ophthalmologist and undergo frequent eye exams. These are essential for monitoring symptoms of this disease and detecting it early, before it presents obvious symptoms. Indeed, early and effective treatment can be implemented to prevent any deterioration of vision.

 

What is the Cost of Glaucoma Surgery and What are the Variables Influencing Associated Fees?

Glaucoma is an eye condition that can cause irreversible damage to vision. In some cases, surgery may be necessary to reduce pressure inside the eye and prevent further vision loss.

It is important to note that the cost of glaucoma surgery can vary depending on various factors such as the type of procedure used and the geographical location of the intervention. It is therefore essential to consider these factors before planning such an operation. In Tunisia, the intervention costs approximately 800 EUR. The costs for an intervention in case of glaucoma amount to 1400 euros in France, but fortunately, social security can cover part, or even all, of the costs depending on the severity of the disease and the doctor's recommendations.

For some patients, refractive surgery options may be considered, but these are not covered by social security and may be more expensive. It is crucial to discuss with a glaucoma expert the different treatment options and associated expenses in order to make an informed decision on the best course of action for your specific situation.

 

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