Introduction
Trabeculectomy is a common surgical procedure used to treat glaucoma, a serious eye condition characterized by increased pressure within the eye (intraocular pressure, or IOP). This elevated pressure can damage the optic nerve, leading to progressive and irreversible vision loss. A trabeculectomy is typically recommended when medications (eye drops) and laser treatments have failed to adequately lower the eye pressure. The goal of the surgery is not to restore lost vision, but to halt further damage by creating a new drainage pathway for the fluid inside the eye (aqueous humor) to exit, thereby lowering the pressure to a safe level.

Surgical Procedure
Trabeculectomy is usually performed in an operating room under local anesthesia (with sedation) or general anesthesia. It takes about 45 to 60 minutes.
The surgeon makes an incision in the conjunctiva, the clear membrane covering the white part of the eye (sclera). A small flap is then created in the sclera itself. Underneath this flap, the surgeon removes a tiny piece of tissue from the eye’s natural drainage system (the trabecular meshwork). This creates a new, microscopic channel for fluid to drain out of the eye.
The fluid flows through this new channel and collects under the conjunctiva, creating a small, elevated blister-like bump called a “bleb.” The bleb is usually located under the upper eyelid and is not visible unless the eyelid is lifted. The fluid in the bleb is eventually absorbed into the bloodstream. The scleral flap is stitched loosely to control the rate of fluid drainage, and the conjunctiva is sutured closed.

Surgical Risks
As a delicate procedure on the eye, trabeculectomy carries significant risks, although it is often necessary to prevent blindness.

General Complications
Common post-operative issues include:
– Blurry vision: Vision is often significantly blurred immediately after surgery and may take weeks or even months to stabilize and return to its pre-surgery baseline.
– Eye discomfort: The eye may feel scratchy, red, and swollen.
– Drooping of the upper eyelid (ptosis), which is usually temporary.

Rare but Serious Complications
Severe complications can affect vision or require further intervention:
– Infection (blebitis or endophthalmitis): Because a new channel is created, there is a lifelong, albeit small, risk of severe infection entering the eye through the bleb.
– Hypotony (pressure too low): If fluid drains too quickly, the eye pressure can drop too low, potentially causing the eye to shrink or the retina to detach.
– Elevated pressure: The drainage hole can scar over and close up, causing the pressure to rise again and necessitating further surgery.
– Bleeding inside the eye.
– Cataract formation: Glaucoma surgery can accelerate the development of a cataract.

Pre-operative Preparation
– Medical Evaluation: Comprehensive eye exams, visual field tests, and optic nerve imaging are required.
– Medication Management: You may need to stop certain blood-thinning medications. Your doctor will provide specific instructions on whether to continue your glaucoma eye drops leading up to the surgery.
– Fasting: If general anesthesia or sedation is used, you will need to fast for 8 to 12 hours before the procedure.

Post-operative Care
You will go home the same day with a protective eye shield. The post-operative period requires close monitoring. You will have frequent visits to the eye doctor in the weeks following surgery to check the eye pressure, assess the healing of the bleb, and possibly adjust or remove sutures to optimize fluid flow.

Wound Care
– Strict adherence to the eye drop regimen is critical. You will use antibiotic drops to prevent infection and steroid drops to reduce inflammation and prevent the body from scarring the new drainage hole closed.
– Wear the protective eye shield while sleeping.
– Do not rub or press on the eye.
– Avoid getting water, soap, or dirt in the eye.

Diet
A normal diet can be resumed, but it is advisable to avoid heavy straining during bowel movements (which increases eye pressure), so a high-fiber diet is beneficial.

Post-discharge Notes
Recovery is gradual.
– Avoid strenuous activities, heavy lifting, bending over, or any activity that increases pressure in the head and eyes for several weeks.
– Avoid reading or using screens extensively for the first few days if it causes discomfort.
– Contact your doctor immediately if you experience severe or worsening pain, a sudden drop in vision, increased redness, or any discharge from the eye, as these could be signs of a serious infection or complication.