During trabeculectomy-sometimes also called
filtration surgery-a piece of tissue in the
drainage angle of the eye is removed, creating an
opening. The opening is partially covered with a flap of tissue from the
sclera, the white part of the eye, and the conjunctiva, the clear thin covering
over the sclera. This new opening allows fluid (aqueous humor) to
drain out of the eye, bypassing the clogged drainage channels of the
As the fluid flows
through the new drainage opening, the tissue over the opening rises to form a
little blister or bubble, called a bleb. The bleb is located where the sclera,
or white of the eye, joins the iris, the colored part of the eye. During office
visits after surgery, the doctor looks at the bleb to make sure that fluid is
still draining out of the new opening. Not all blebs have to be easily seen to
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The person does not have to be
admitted to the hospital. But children may stay in the hospital overnight
following surgery. And in some cases, your doctor may recommend that you stay
in the hospital.
Right after surgery, antibiotics may be
applied to the eye. Also, antibiotics may be injected under the lining of the
eyelid (conjunctiva). After surgery, the eyelid is usually taped shut, and a
hard covering (eye shield) is placed over the eye.
wears a dressing over the eye during the first night after surgery and wears
the eye shield at bedtime for up to a month. Corticosteroids are usually
applied to the eye for about 1 to 2 months after surgery to decrease
inflammation in the eye.
People who have a trabeculectomy without
being admitted to the hospital usually have a checkup the following day with
their eye specialist.
Any activity that might jar the eye needs to
be avoided after surgery. People usually need to avoid bending, lifting, or
straining for several weeks after surgery.
After surgery, people
who have problems with constipation may need to take laxatives to avoid
straining while trying to pass stools. Straining can raise the pressure inside
the eye, increasing the risk of damage to the optic nerve or bleeding.
Usually there is mild discomfort after a trabeculectomy. Severe pain may
be a sign of complications. If you have severe pain after a trabeculectomy,
call your doctor immediately.
The new opening created by
trabeculectomy allows fluid to gather under the tissue that lines the eyeball
(conjunctiva), where it is absorbed into the bloodstream.
This procedure has been shown to reduce IOP and the need for medical treatment.1 But many people need
another trabeculectomy surgery or other treatments for glaucoma. Trabeculectomy
is less likely to be successful in:
have congenital glaucoma.
People who have difficult-to-control
glaucoma in which new blood vessels grow on the iris (neovascular secondary
The long-term effectiveness of trabeculectomy surgery in
preventing loss of vision from glaucoma is less certain. It is not a cure, and
visual field loss can continue despite surgery
The most common problem after a trabeculectomy
is scarring of the opening. Scarring prevents fluid drainage from the eye and
interferes with the proper function of the bleb. Mitomycin-C is commonly used
during surgery to prevent scarring. It is more commonly used than
5-fluorouracil, but it cannot be used after surgery. 5-fluorouracil can be used
during the surgery or injected into the thin tissue (conjunctiva) covering the
eye after surgery to prevent scarring.
Other complications of this
surgery that may develop soon after surgery include:
Severe blurring of vision for several weeks
Bleeding in the eye.
Extremely low pressures
in the eye, which may result in blurred vision that results from clouding of
the lens (cataract), fluid buildup under the nerve layer in the
Sudden, permanent loss of central vision. This risk
depends in part on how much central vision had been lost before surgery.
Infection in the eye.
High pressure in the eye,
causing the space in the front part of the eye (anterior chamber) to collapse
(malignant glaucoma). This is rare.
Late complications after a trabeculectomy may
A cataract that is worse than it was before
Continued changes in the nerve at the back of the
eye related to glaucoma.
Droopy eyelid (a
very slight droop of the eyelid is common).
What To Think About
Trabeculectomy is the most
frequently used surgery to treat glaucoma. If you are having this type of
surgery, talk with your doctor about its possible risks and benefits for
Very low pressures in the eye, infection in the bubble
created by the surgery (bleb), clouding of the lens (cataracts), or swelling of
the clear covering (corneal edema) over the colored part of the eye (bullous
keratopathy) can sometimes occur.
Scarring of the opening after
surgery is the most common problem with trabeculectomy. The risk of scarring is
decreased when corticosteroids are used after surgery.
5-fluorouracil may be used to prevent scarring. If
bleb failure continues to be a problem, a plastic drainage device called a
seton may be placed in the eye to help drain fluid. (See
seton glaucoma surgery in the Surgery section of this topic.)
Trabeculectomy may be combined with surgery to remove a
Stitches placed during surgery
may be cut after surgery if fluid is not draining well from the eye. Your doctor may ask you to massage the bleb to help the fluid drain.
American Academy of Ophthalmology (2005).
Primary Open-Angle Glaucoma, Limited Revision (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology.
Also available online: http://www.aap.org/ppp.
Primary Medical Reviewer
Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer
Christopher J. Rudnisky, MD, MPH, FRCSC - Ophthalmology
May 5, 2010
WebMD Medical Reference from Healthwise
May 05, 2010
This information is not intended to replace the advice of a doctor.
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