Glaucoma is a leading cause of irreversible blindness, often caused by increased intraocular pressure (IOP) damaging the optic nerve. When medications and laser treatments fail to control IOP, trabeculectomy becomes a key surgical option. This procedure, often called the "gold standard" in glaucoma surgery, creates a new drainage pathway for excess fluid, reducing pressure and preventing further vision loss.
First performed in the 1960s, trabeculectomy has evolved with advanced techniques to improve success rates. It’s particularly effective for open-angle glaucoma, though it can also be used for other types. Patients considering this surgery often have concerns about risks, recovery, and long-term outcomes—topics we’ll explore in detail.
Understanding trabeculectomy empowers patients to make informed decisions about their eye health. Whether you’re newly diagnosed or exploring surgical options, this guide provides clear, actionable insights.
A trabeculectomy is a surgical procedure designed to lower intraocular pressure (IOP) by creating a tiny flap in the sclera (white of the eye) and a filtration bleb under the conjunctiva (outer eye layer). This new pathway allows aqueous humor—the fluid inside the eye—to drain, reducing pressure that can damage the optic nerve.
The primary goal is to prevent further vision loss in glaucoma patients when other treatments (eyedrops, oral medications, or laser therapy) fail. Unlike cataract surgery, which restores vision, trabeculectomy aims to preserve existing vision by halting disease progression.
Modern variations include the use of anti-scarring agents like mitomycin-C (MMC) or 5-fluorouracil (5-FU) to improve drainage efficiency. While minimally invasive glaucoma surgeries (MIGS) are gaining popularity, trabeculectomy remains a reliable option for moderate to advanced glaucoma.
Trabeculectomy is typically recommended for patients with uncontrolled glaucoma despite maximal medical therapy. Ideal candidates include those with:
However, it may be less suitable for patients with active eye infections, severe conjunctival scarring, or certain types of angle-closure glaucoma. Your ophthalmologist will evaluate factors like age, glaucoma severity, and overall eye health before recommending surgery.
The surgery, performed under local or general anesthesia, follows these key steps:
The procedure takes 45–60 minutes. Patients are monitored for a few hours post-op before discharge.
While generally safe, trabeculectomy carries potential risks, including:
Long-term monitoring is crucial to address complications early. 5–15% of patients may need a revision surgery within 5 years.
Recovery varies but typically follows this timeline:
Do’s: Use prescribed drops, wear an eye shield at night, attend all follow-ups. Don’ts: Rub your eye, swim, or expose it to dust/dirt until cleared by your doctor.
Studies show trabeculectomy achieves 60–80% success in lowering IOP to target levels after 5 years. Success depends on:
While some patients eventually need additional treatments, trabeculectomy often delays disease progression for years.
For those unsuitable for trabeculectomy, options include:
Your doctor will recommend the best approach based on glaucoma type and severity.
Is trabeculectomy painful?
No—anesthesia ensures comfort during surgery. Mild discomfort or gritty sensations may occur post-op, managed with prescribed drops.
How soon can I drive after surgery?
Most patients wait 1–2 weeks until vision stabilizes and their doctor approves.
Will I still need glaucoma medications after surgery?
Some patients reduce or eliminate medications, but others may still need them for optimal IOP control.