Trabeculectomy

What is a trabeculectomy?

A trabeculectomy is a glaucoma surgery that relieves pressure buildup inside your eye. It’s typically an outpatient surgery, meaning you can usually go home the same day.

Trabeculectomy (pronounced “trah-BECK-yoo-LECK-tuh-ME”) isn’t a first-line treatment for glaucoma. Trabeculectomy has good success rates, but it’s more invasive. That’s why it’s usually only an option when other treatment approaches aren’t effective.

How trabeculectomy works

Trabeculectomy creates a new way for fluid from the anterior chamber to drain, lowering the pressure inside your eye. This procedure can’t undo vision loss after it happens, but it can prevent vision loss from getting worse.

Inside your eye, between the cornea and the lens, is a fluid called aqueous humor. That fluid is supposed to help your eye hold its shape. It also circulates and drains as new fluid replaces it.

But when you have glaucoma, too much pressure inside your eye damages the optic nerve at the back of your eye. That can cause permanent damage, vision loss and even total blindness.

How should I prepare for trabeculectomy?

Your eye surgeon (an ophthalmologist) will tell you how to prepare for this procedure. Part of the preparation includes doing tests and checking other details about your eye health to make sure trabeculectomy is a good option for you.

Some of the things they’ll discuss with you include:

• Anesthesia options for the procedure (it can involve local or general anesthetic).
• Any and all medications and supplements you currently take.
• Which medications you should keep taking, which you should stop and how to stop taking certain medications (if necessary).
• If you’ll need to fast (not eat or drink) within a certain frame before your surgery.
• Making sure someone can drive you to and from your procedure and help you afterward.

What happens during trabeculectomy?

During a trabeculectomy, your eye surgeon will have you lay on your back on an operating table. They usually insert an intravenous (IV) line if they have to give you certain medications, but that isn’t always necessary.

Before the actual procedure starts, they’ll also place a small, clip-like device that holds your eyelids open. They’ll also numb the eye and may supplement topical anesthetic with a nerve block. Usually, local anesthesia is all this procedure requires, but some people may need general anesthesia for specific reasons. The difference between these anesthesia types works like so:

• If you’re receiving local anesthesia (with or without a nerve block), you’ll be awake for the procedure. Your eye will be numb so you won’t have any pain during the surgery. You might feel some movement or pressure, but it shouldn’t hurt. If you’re worried about anxiety during the procedure, tell your eye surgeon during your pre-surgery visits. They can talk to you about options to prevent or limit that.
• If you receive general anesthesia, you’ll be asleep for the procedure. That keeps you from feeling any pain during the surgery.

During the procedure, your eye surgeon will make a small flap or opening on your eye surface. They’ll then make a very tiny opening and route for aqueous humor fluid to pass through. That will leave a small bump on your eye surface called a “bleb” under your upper eyelid. Your body can reabsorb the fluid from there.

Depending on your specific case and needs, your surgeon may inject certain medications to keep scar tissue from forming and blocking the opening. They’ll then place sutures that they can remove later, if necessary, to lower pressure in your eye further.

Once your surgeon finishes the surgery, they’ll cover it with a bandage or patch (dressing) so your eye can heal. They’ll also give you an eye shield — a firm, wearable item to keep anything from touching your eye. They’ll monitor you for a short time after your surgery (the amount of time varies, mainly depending on the type of anesthesia used). After that, you can go home.

How long does trabeculectomy take?

A trabeculectomy surgery takes about an hour (not counting any prep time before, or monitoring after, the surgery).

What happens after a trabeculectomy?

There are a few things you should expect after your surgery. Some of them include:

• The first night after your surgery: You’ll continue wearing the bandage or patch overnight. Your provider may have you wear your eye shield every time you sleep for at least a month after surgery. You’ll also need to put medicated eye drops in the affected eye multiple times a day. Your eye surgeon will tell you how often and for how long.
• The day after your surgery: Your eye care specialist will schedule a follow-up appointment the day after your surgery to remove the bandage/patch covering your eye. That follow-up visit is an important part of making sure this surgery works correctly and preventing complications.
• One week after your surgery: Your eye care specialist will likely schedule another follow-up visit a week after your surgery. That will let them monitor and track your recovery. After this visit, you should expect to see them for follow-up visits every one to two weeks for at least two months. Depending on how your eye is healing, you may need to see your provider more frequently.

Your eye specialist will monitor your eye pressure as part of your follow-up visits, which is part of why it’s so important to go to those visits. If your eye pressure is still too high, they may use a special laser to release some of the sutures, helping lower your eye pressure further.

What are the benefits of trabeculectomy?

Trabeculectomy is an important surgery option because of the following:

• It’s effective, with success rates of 60% to 80% within five years after the procedure.
• It’s safe, and complications from trabeculectomy are rare.
• It provides an option when other treatments don’t help.

What are the risks or complications of this procedure?

Trabeculectomy can cause or speed up the formation of cataracts. But experts know to expect that, and these are curable with cataract surgery. Other complications include:

• Infection.
• Pain.
• Bleeding.
• Worsened vision.
• Vision loss.

Bleb displacement or enlargement, which can cause a droopy eyelid (ptosis) or other changes.

What is the recovery time?

Most people will need at least four to six weeks for their eyes to recover fully after a trabeculectomy procedure.

During that time, it’s important to remember the following:

DO:

• Take your medicated eye drops exactly as instructed. They help prevent infections and reduce inflammation after the procedure.
• See your provider for follow-ups as recommended. Those visits are a key part of making sure you get the best possible results.
• Wear your eye shield when you sleep. It’s a vital way to keep your eye safe while it heals.

DON’T

• Rub your eye. That can affect how it heals (and it’ll probably be painful, too).
• Strain. Lifting, bending or straining while you poop can all raise the pressure in your eye (which can affect how it heals). If you have issues with constipation, make sure to tell your eye surgeon before your surgery. They can prescribe medications to soften your poop and prevent straining. Your provider will tell you an exact weight limit on what you can lift. They’ll also give you specific guidance on activities to avoid and how long you’ll need to do so.

When should I call my healthcare provider?

It’s normal to have mild discomfort after your trabeculectomy surgery. But it’s not normal to have severe pain. If you have severe pain, call your eye care specialist immediately.

The anti-inflammatory medications often used for this procedure make the affected eye vulnerable to infection, and that vulnerability can last for years. Because of that, you shouldn’t ignore symptoms of an eye infection, even if it’s been months or years since you had trabeculectomy.

You should call your eye surgeon or specialist if you notice any of the following:

• Fever.
• Unusually teary or watery eyes (epiphora).
• Discharge, oozing or bleeding from your eye.
• Sudden vision loss.

Can trabeculectomy reverse vision loss from glaucoma?

No, trabeculectomy can’t reverse vision loss from glaucoma. But it can lower eye pressure enough to stop or slow vision loss.

How painful is a trabeculectomy?

Trabeculectomy surgery itself doesn’t hurt because your provider will use some form of anesthesia to prevent pain during the procedure. Immediately after the procedure, you may have some eye pain, but it shouldn’t be severe.

During your recovery, discomfort (a feeling that’s unpleasant but not painful) or mild pain is normal, but severe pain isn’t. Talk to your eye surgeon before your surgery to learn more about the pain management options that may help during your recovery.

What happens when trabeculectomy fails?

If trabeculectomy isn’t able to lower your eye pressure to prevent further damage from glaucoma, there are still treatment options. The first treatment option is placing drainage tubes in your eye so aqueous humor fluid can drain.

If that doesn’t help or isn’t an option, your provider may recommend a cyclodestructive procedure. These intentionally damage parts of the ciliary body (that’s the part of your eye that makes aqueous humor fluid). There are many ways to do this, but they usually involve using a laser.

One downside to cyclodestructive procedures is that your ciliary body regenerates. That means you’ll probably need multiple treatments to get the effect you need.

A note from Cleveland Clinic

It’s easy to take your sense of vision for granted when it works correctly. But if you face the possibility of vision loss and blindness, that can be a source of anxiety, fear or even anger. Trabeculectomy is important because it offers hope when first-line glaucoma treatments like medications and laser procedures aren’t helpful. An eye care specialist like an ophthalmologist can tell you more about this procedure and whether it’s likely to help you.