Surgical Procedure of Trabeculectomy: Steps, Execution, and Possible Complications
Glaucoma, a condition that affects the optic nerve and can lead to permanent vision loss, requires careful management. Two common surgical procedures used to treat glaucoma are trabeculectomy and trabeculotomy. These procedures aim to improve aqueous humor outflow, thus reducing internal eye pressure (IOP).
Differences in Procedure
Trabeculectomy creates a new drainage pathway by removing part of the trabecular meshwork and adjacent tissue, forming a filtering bleb where aqueous humor can exit, thereby lowering IOP. On the other hand, trabeculotomy involves incising or opening the trabecular meshwork internally (usually via the Schlemm’s canal) to enhance natural aqueous outflow through the conventional pathway without creating an external bleb.
When Each is Recommended
Trabeculectomy is considered the gold standard surgical treatment for glaucoma, especially for more advanced or medically uncontrolled cases, due to its reliable and significant IOP lowering effect. It is often chosen when medications and less invasive surgeries have failed or are insufficient.
Trabeculotomy (often combined with other minimally invasive glaucoma surgeries, MIGS) is typically recommended for earlier-stage glaucoma or cases where less invasive intervention is appropriate, such as some primary angle-closure glaucoma (PACG) patients. The combined approach (e.g., phacoemulsification + goniosynechialysis + trabeculotomy) can be effective in opening pathological trabecular meshwork and synechiae with potentially fewer complications and faster recovery than trabeculectomy.
Summary Table
| Aspect | Trabeculectomy | Trabeculotomy | |-----------------------|----------------------------------------|--------------------------------------------| | Surgical approach | Creates external fistula and filtering bleb | Internal opening of trabecular meshwork through Schlemm's canal | | Target tissue | Trabecular meshwork + adjacent tissues | Trabecular meshwork | | Aqueous drainage pathway | External (subconjunctival space) | Natural conventional outflow (Schlemm’s canal) | | Indications | Advanced, uncontrolled glaucoma | Early to moderate glaucoma; angle-closure glaucoma adjunct | | Risks/complications | Bleb scarring, hypotony, wound healing issues | Generally fewer severe complications; less invasive | | IOP lowering effect | Strong and sustained | Moderate; sometimes combined with other procedures |
Preparation and Recovery
Before a trabeculectomy, a person may need to have an eye exam, additional testing, and a review of their medical history to determine any necessary modifications. The procedure is usually an outpatient procedure. A person will spend some time in a recovery room after the surgery. Full recovery from a trabeculectomy can take 4-6 weeks.
Local or general anesthesia is provided by an anesthesiologist for the procedure. A trabeculectomy procedure typically takes up to 1 hour.
It's essential to discuss anesthesia options with your doctor, as different techniques have varying risk factors. Additionally, medications to prevent scarring can increase the chance of eye infections, leading to unusual eye discharge, redness, and discomfort.
In conclusion, both trabeculectomy and trabeculotomy are valuable tools in managing glaucoma. The choice between the two depends on the severity of the condition, the stage of the disease, and the patient's overall health. Consult with your ophthalmologist to determine the best course of treatment for your unique situation.
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