Let's learn simply about trabeculectomy surgery for glaucoma.

As you probably know , glaucoma is a condition in which the pressure inside the eye increases, which can gradually damage our vision. In most cases, this pressure can be controlled with eye drops . However, sometimes, eye drops alone cannot control the pressure in the eye . In such cases, today we are talking about a special surgery that your doctor may suggest.

What is Trabeculectomy?

Trabeculectomy is a surgical procedure performed to reduce the pressure inside the eye caused by glaucoma. It is not a first-line treatment for glaucoma. This means that doctors do not recommend this surgery as the first option. It is considered only if other treatments, such as eye drops, have failed to control the pressure in the eye.

Simply put, it's like creating a new drain to drain excess fluid from the eye. This is usually not a major surgery, meaning you can go home the same day.

What actually happens with this surgery?

Inside our eyes, there is a special fluid that nourishes the eye and keeps it in its proper shape. We call this 'aqueous humor'. This fluid is constantly being produced inside the eye and flowing out of the eye. It happens like a cycle.

However, in glaucoma, this fluid is blocked from flowing out of the eye. This fluid then builds up inside the eye, increasing pressure. This high pressure damages the optic nerve, which connects our eyes to the brain. This damage gradually causes vision loss.

Trabeculectomy surgery creates a new path for the excess fluid (aqueous humor) to drain out of the eye, thereby reducing the pressure inside the eye.

How do you prepare before surgery?

Your eye surgeon will give you all the advice you need before the surgery. During this time, your eyes will be examined and you will be determined to be suitable for the surgery. Before the surgery, the doctor will discuss the following with you:

• Anesthesia : Whether the surgery will be performed under local anesthesia or general anesthesia.
• Medications you are taking: You should tell your doctor about all medications you are currently taking, including vitamins and herbal remedies. Some medications may need to be stopped before surgery.
• Fasting : You will be advised how many hours you should abstain from eating or drinking before surgery.
• Someone to help: It is essential to have someone to drive you home after surgery and to help you at home.

What happens during the surgery?

During the surgery, you will lie down on an operating table. If necessary, a small tube (IV line) may be connected to a vein in your arm to give you medication. Then, a small clip-like device will be used to hold your eyelids open.

Next, the eye is anesthetized. Most often, only the eye is numbed (local anesthesia). You are then conscious, but you do not feel any pain. Although you may feel some pressure, there is no pain. If you are worried about it, talk to the doctor beforehand.

In some special cases, the surgery is performed under general anesthesia, putting the patient completely asleep.

Then, the surgeon makes a very small incision in the white part of the eye (the conjunctiva and sclera), creating a small passage for the fluid we talked about earlier to escape. The fluid that comes out of this passage collects inside a membrane under the upper eyelid, forming a small bubble-like structure. This is called a 'bleb' . Don't worry, this bubble is not visible from the outside. The fluid that collects here is absorbed back into the body.

Sometimes, a special medicine is injected to prevent the incision from scarring and closing. Finally, a few stitches are placed that can be removed later if necessary, and the eye is closed with a bandage/patch. In addition, you will be asked to wear an eye shield to prevent anything from getting into your eye. The surgery usually takes about an hour.

What should we do after the surgery?

The recovery period after surgery is very important. It usually takes about 4 to 6 weeks for the eye to fully heal. There are a few things you should definitely follow during this time.

Follow-up clinics after surgery

You will have to see the doctor the day after the surgery. The bandage will be removed and your eyes will be examined. After that, you will be asked to come to the clinic once or twice a week for the first two to three weeks. The pressure in your eye will be measured and, if necessary, one or two stitches can be cut with a laser to further reduce the pressure. So, don't miss out on going to these clinics.

What are the benefits and possible complications of this surgery?

Trabeculectomy surgery is a very successful treatment. However, like any surgery, there are some risks involved.

• Benefits:
• There is a high success rate of 60% - 80% 5 years after surgery.
• This is a good option for those who have failed other treatments.
• Often a safe surgery.

• Risks and Complications:
• Cataracts: The rate of cataracts may increase after this surgery. But this is something that doctors expect. Also, cataracts can be completely cured with surgery.
• Infection : There is a small risk of developing an eye infection.
• Bleeding: Bleeding inside the eye may occur.
• Blurred vision: Sometimes vision may become temporarily blurred.
• Problems with the bleb: Enlargement or changes in the bleb can cause conditions such as drooping eyelids (ptosis).

When should I see a doctor immediately?

It is normal to have some discomfort and redness after surgery. However, it is not normal to have severe pain . Also, the risk of infection can persist for months, even years, after surgery. Therefore, if you experience any of the following symptoms, immediately go to the doctor who performed your surgery or to the hospital's Emergency Department (ETU).

• Severe eye pain
• Fever
• Excessive tearing (epiphora) or discharge of pus from the eye
• Sudden loss or decrease in vision

If the surgery is unsuccessful, meaning the eye pressure doesn't go down as expected, don't worry. There are other treatment options. Your doctor will explain to you things like inserting a small tube (drainage tube) to drain the fluid inside the eye or laser treatment (cyclodestructive procedure).