What is trabeculectomy?
Trabeculectomy is a type of surgery that is done to treat glaucoma by lowering the
pressure in your eye. This procedure may be advised when other treatment has not worked.
The front part of your eye is full of fluid. (This is the area in front of the colored
part of your eye, the iris.) Normally, this fluid slowly drains out of your eye through
a network of tubes. It goes out into your veins.
When you have glaucoma, fluid may drain too slowly. This can cause the pressure in
your eye to increase. This increases pressure on your optic nerve. This nerve is important
for sending visual information to your brain. If the pressure increases too much,
it can damage your optic nerve. This causes vision loss.
During trabeculectomy, your surgeon makes a new opening for fluid to leave your eye.
Your eye is numbed. Then your surgeon removes a small piece of tissue from the part
of your eye where the fluid drains out. This allows the fluid to go around the normal
tube out of your eye. A flap of tissue from the white part of your eye (the sclera)
and the thin layer covering your eye (the conjunctiva) partly cover this opening.
This can help reduce the pressure inside your eye. This can help prevent future vision
Why might I need a trabeculectomy?
You might need this procedure if you have glaucoma that you have not been able to
control with other treatment such as eye drops or laser treatment. Without treatment,
people with glaucoma lose their side (peripheral) vision over time. Less commonly,
central vision may decrease too. This can cause a person to become totally blind.
Your eye care provider (ophthalmologist) might advise trabeculectomy to help keep
your glaucoma from getting worse. But it does not restore vision that has already
been lost. Trabeculectomy is a possible treatment for both closed-angle and open-angle
types of glaucoma. It is also a possible treatment for primary and secondary types
Your eye care provider might want to try other treatments first before doing a trabeculectomy.
For example, he or she may want to try medicines to lower the pressure in your eye.
A procedure called laser trabeculoplasty is also a choice for some people. If these
treatments don’t work, your eye care provider may advise trabeculectomy. Surgical
placement of a tube (shunt) is another possible surgery for some people.
Each of these treatment choices has its own risks and benefits. Ask your eye care
provider why trabeculectomy may be the most effective treatment for you.
What are the risks of a trabeculectomy?
Many people do well with trabeculectomy. But complications from the surgery can sometimes
happen. Some possible risks include:
Tearing of the conjunctiva
Tearing of the sclera (this is rare)
High pressure inside the eye
Abnormally low pressure inside the eye
Bleeding into the eye
There is also a risk that the trabeculectomy will not be effective. If this happens,
you might need a repeat surgery.
Your risks may be different according to your age, your other health conditions, and
the specific anatomy of your eye. Talk with your eye care provider about all your
concerns. Ask about the risks that apply to you.
How do I get ready for a trabeculectomy?
Talk with your eye care provider about how to get ready for your trabeculectomy. Ask
if you need to stop taking any medicines before the procedure. Follow any directions
you are given for not eating or drinking before the surgery.
Your eye care provider may want certain tests before the procedure, to get a better
idea of the anatomy involved. These might include:
What happens during a trabeculectomy?
Talk with your eye care provider about what will happen during your trabeculectomy.
An eye care provider (ophthalmologist) often does the surgery. In general, you can
expect the following:
You may be awake during the surgery. You will receive a medicine to help you relax.
You may also receive a shot (injection) or a topical numbing medicine (anesthetic)
to numb the eye. This will keep you from feeling anything during the surgery.
In other cases, you may be given medicine (general anesthesia) to put you to sleep.
If this is the case, you will sleep deeply during the surgery. You won’t remember
You may receive an antifibrotic medicine on your eye during and after the surgery.
This can help reduce scarring and the chance for complications.
Your surgeon may rotate your eye during the surgery and temporarily secure it with
Your surgeon will make a cut (incision) at an angle along the conjunctiva on the side
of your eye.
Your surgeon will make an incision partway through your sclera, making a flap. The
incision will connect all the way to the cavity containing the fluid in the front
of your eye. The surgeon will remove a small piece of tissue from the part of the
eye where fluid drains out.
Your surgeon will make a small hole in your iris.
Your surgeon will close the area and remove the stitch that was rotating your eye.
You may receive antibiotics in your eye.
Your eye will be covered with a patch.
What happens after a trabeculectomy?
Ask your eye care provider about what to expect after your surgery. In most cases,
you will be able to go home the same day. Plan to have someone drive you home from
Follow your eye care provider’s instructions about caring for your eye. You may need
to take antibiotics to help prevent infection. You may also need other medicines,
such as steroids or antifibrotics. You may need to continue to cover your eye for
a while after your surgery.
The area may be a little sore after the procedure. But you should be able to take
over-the-counter pain medicines. Ask your eye care provider if you should not do any
certain activities while you recover.
You will need close follow-up with your eye care provider to see if the surgery was
effective. You may have a scheduled appointment the day after the procedure. Your
eye care provider will need to make sure the new drainage opening is working well.
You will need continued follow-up care to watch how you are doing after your surgery.
You may need to have stitches in your eye removed in a follow-up appointment a few
weeks after your surgery. Seek medical care right away if you have bleeding, fever,
worsening vision, increasing eye pain, or swelling.
Before you agree to the test or the procedure make sure you know:
The name of the test or procedure
The reason you are having the test or procedure
What results to expect and what they mean
The risks and benefits of the test or procedure
What the possible side effects or complications are
When and where you are to have the test or procedure
Who will do the test or procedure and what that person’s qualifications are
What would happen if you did not have the test or procedure
Any alternative tests or procedures to think about
When and how will you get the results
Who to call after the test or procedure if you have questions or problems
How much will you have to pay for the test or procedure