Trabeculectomy is a surgical treatment procedure for treating high intraocular pressure in glaucoma. The doctor surgically creates a valve through which the intraocular pressure can be regulated.
Here you will find further information and selected trabeculectomy specialists and centers.
The erosion of the optic nerve is known as glaucoma. The steadily progressive damage to the optic nerve means that more and more areas of the retina are no longer reached. These areas then gradually disappear from the field of vision and become black.
Without therapy, the patient goes blind as the disease progresses. It is therefore advisable for patients to consult a specialist doctor as soon as possible if glaucoma is suspected. They can make a diagnosis and initiate treatment.
The exact cause of glaucoma has not yet been conclusively clarified. The most common trigger is an increase in intraocular pressure due to too much aqueous humor in the eye.
In the case of glaucoma, the intraocular pressure is too high, causing damage to the optic nerve at the back of the eye © Henrie | AdobeStock
The optic nerve can only withstand a certain intraocular pressure without damage. If the pressure rises above this limit, damage to the nerve tissue occurs without glaucoma surgery. Even brief but severe pressure can be enough to cause this.
The optic nerve, which starts at the retina and leaves the eyeball at the so-called optic disc towards the back, is particularly at risk.
A certain reduction in pressure can also be achieved with medication. However, only a trabeculectomy can provide lasting relief.
The nerve damage caused by glaucoma is irreversible, i.e. the damaged nerve areas cannot be restored. Treatment should therefore be carried out as quickly as possible. The aim is to prevent further damage to the nerve tissue.
It should be clarified in advance whether a laser surgical procedure is an alternative to trabeculectomy. A laser procedure is often an option, with which the doctor partially obliterates the cells near the epidermis that are causing the fluid outflow. This subsequently reduces the intraocular pressure.
However, depending on the state of health of the eye, a conventional trabeculectomy may be more suitable. Correctly applied and with careful aftercare, it is a very effective means of lowering intraocular pressure.
If the glaucoma is already very advanced, trabeculectomy is the appropriate treatment in almost all cases.
A trabeculectomy can be performed under both local and general anesthesia. The doctor must carefully weigh up the success of the treatment against the risks of general anesthesia.
Local anesthesia avoids the risks of general anesthesia. However, general anesthesia is more comfortable for both the patient and the surgeon and makes the work easier. However, the final decision is made by the patient. However, the patient needs sufficient information about the advantages and disadvantages of both options.
During a trabeculectomy, an artificial drain for excess aqueous humor is surgically created. This creates a kind of pressure valve: if the intraocular pressure becomes too high, aqueous humor can flow out and the pressure drops again before the optic nerve is further damaged.
Trabeculectomy is therefore a standard procedure for the treatment of glaucoma.
During the trabeculectomy, an opening is created in the sclera of the eye to drain the aqueous humor. The accumulation of aqueous humor under the conjunctiva creates a "drainage cushion".
The fluid drained from the inside of the eye can initially collect here. It later runs under the connective tissue of the eye and is reabsorbed by the body.
The surgeon also detaches a flap from the underlying sclera below the conjunctiva. After successful further surgery, the surgeon sutures this flap in such a way that a higher fluid drainage can take place in the direction of the second, deeper opening in the event of high intraocular pressure.
The surgeon makes this second opening in the deeper skin layer of the eyeball. The incision required for this is made directly under the previously excised scleral flap. A "drain" is to be created here. This allows the aqueous humor to flow out of the "fluid reservoir" or "drainage cushion".
The experience and skill of the surgeon is of great importance here. He must assess the necessary laxity of this "pressure valve" and carefully place a suture.
The surgeon must also take wound healing into account. After the trabeculectomy, fluid from the eye should enter the "fluid reservoir" created by the correct suturing of the scleral flap. From there, it can drain through the second, deeper opening.
The doctor checks the correct functioning of the scleral valve flap during the procedure by carefully testing the aqueous humor.
Aqueous humor that runs over the iris after the operation can restrict the patient's field of vision. To prevent this, the doctor removes a small piece of the iris. This removal of part of the iris during trabeculectomy is also known as an iridectomy.
Trabeculectomy does not always reduce the intraocular pressure sufficiently. In these cases, a second operation may be necessary at a later date.
Many patients report astigmatism after a trabeculectomy. This is caused by the sutures placed. Astigmatism is not uncommon and usually improves quickly after successful aftercare.
If the surgeon uses dissolvable suture material, this can pose a further risk to the patient. If the suture dissolves in the eye, this can cause an inflammatory reaction.
A serious consequence of trabeculectomy can be the formation of cataracts in the treated eye. However, according to the current state of medicine, this can usually be treated without any problems using the usual procedures.
In some cases, a fibrin reaction occurs after glaucoma surgery. Rarer complications such as
and their causes usually have to be examined in more detail by doctors on a case-by-case basis.
The natural healing process leads to the formation of scars on the seepage cushion, a so-called encapsulation. This encapsulation often hinders the success of the operation, as it leads to a renewed increase in intraocular pressure. Needling can be performed to reduce encapsulation.
This involves injecting the patient with 5-FU in the form of syringes directly into the scarred tissue. The tissue is loosened by puncturing or incisions so that the seepage cushion can resume its work. The treatment of such encapsulation of the seepage cushion is also possible with 5-FU alone, without needling.
Encapsulation of the oozing pad after a trabeculectomy is a well-known and much-discussed problem. One possible option would be to support an inadequately functioning seepage cushion by administering medication. If the scarring cannot be brought under control with postoperative medication, a second trabeculectomy may be necessary.
The aim of the operation is to permanently regulate the intraocular pressure.
Close monitoring of the success of the treatment after the operation is essential. The permeability of the "drainage cushion" must also be ensured and monitored. These follow-up examinations take place at short intervals after the operation. The patient should attend these appointments conscientiously!
A useful examination to check the intraocular pressure on the day after the trabeculectomy is the daily tensile profile (TTP). This allows doctors to identify short-term pressure peaks in most cases. Renowned ophthalmologists assume that in many cases these peaks in intraocular pressure cause damage to the optic nerve.
The nerve damage that has already occurred due to the increased intraocular pressure cannot be repaired by surgery.
