Glaucoma surgery (trabeculectomy)

The optic nerve carries images from the retina (light-sensitive layer at the back of the eye) to the brain, allowing you to see. Glaucoma is the name given to a group of conditions that cause damage to the optic nerve where it leaves the eye. It affects one in 50 people over the age of 40 and can cause loss of vision.

Glaucoma can be caused by an increase in pressure in the eye. Fluid (aqueous) is constantly made in the eye and drains out slowly into the bloodstream. The pressure in the eye can increase if the fluid does not drain out enough.

Most people don’t know there is a problem in the early stages because it is usually painless, and side vision tends to be affected first. Sometimes the optic nerve can be damaged, even though the pressure in your eye is within the normal range. Your surgeon has recommended surgery to stop or reduce the risk of further damage to your optic nerve.

Alternatives

You can use eye drops to lower the pressure. If they do not work, surgery is usually recommended. Laser treatment may be suitable for you but often the condition comes back.

If you don’t have the operation, your optic nerve will become increasingly damaged. If you leave it untreated you are likely to lose vision in your eye. Surgery will not improve your vision, but may stop it getting worse.

The procedure

The operation usually takes between 45 minutes and an hour.

A trabeculectomy involves draining some of the fluid in your eye to lower the pressure. Your surgeon will make a small draining hole in the lining of the white of your eye. The fluid will drain out into a space in the outer lining of your eye and collect just under your eyelid.

For more information, and if you have any queries about the procedure, speak to your consultant.

Continue your normal medication unless you are told otherwise.

The following lifestyle changes can help make the procedure a success:

  • Giving up smoking
  • Eating healthily. If overweight, you have a greater chance of developing complications
  • Exercising regularly. Your GP can recommend exercises.

Possible complications

  • Some pain is common with all operations
  • Bleeding after surgery
  • Infection, which can result in blurred vision or even permanent loss of vision 
  • Severe bleeding inside the eye during surgery which may cause permanent loss of vision 
  • Bleeding at the front of the eye, which makes vision worse. This is very common and usually settles after a week
  • Too much fluid draining, which is very common and usually settles on its own. If it does not settle, you may need a further operation
  • Developing a cataract, which is very common
  • Reduced vision, caused by glaucoma, which is common
  • Failure of the operation, which is very common. This usually happens if the small hole made to drain the fluid becomes scarred and blocked. You may need eye drops or further treatment to control the pressure.

This is not a definitive list and symptoms will vary with each patient. Please ask your consultant for more information.

Recovery

You should be able to go home a few hours after the operation. However, your doctor may recommend that you stay overnight. Remember, you won’t be able to drive home after the operation.

Your surgeon will need to check your eye the day after the operation and you will need to return the clinic several times during the first few weeks after your operation.

Stitches may be loosened or removed so the fluid can drain better. Your surgeon may inject anti-scarring drugs into the surface of your eye. These procedures are normally painless and are performed after your eye has been numbed with anaesthetic eye drops.

You should be able to return to work a few weeks after the operation. For the first four to six weeks avoid swimming as this will expose your eye to infection. Regular exercise should help your recovery – ask your GP for advice.

Do not drive until you can read a number plate from 20.5m (67 ft).   For more information, speak to your consultant.

Paying for your operation

Glaucoma surgery (trabeculectomy) costs are covered by most medical insurance policies, but please check with your insurer first. If you are paying for your own procedure the cost will be explained and confirmed in writing when you book the procedure. Ask the hospital for a quote beforehand, and ensure that this includes the surgeon’s fee, the anaesthetist’s fee and the hospital charge for your procedure.

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