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CAUSE & SYMPTOMS Primary angle closure glaucoma (‘’narrow or closed angle glaucoma’’) is the less common of the two major...
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article thumbnailMr PH Galloway, MBBS, FRCOphth

Mr Galloway is a Consultant Ophthalmic Surgeon at St James University Hospital, Leeds. His major interests are glaucoma management, and...
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Glaucoma surgery including trabeculectomy
Glaucoma surgery PDF Print E-mail
Written by Administrator   
Friday, 15 January 2010 17:15

Glaucoma surgery is required in some cases if eye pressure remains high - despite the more conservative measures of laser (such as selective laser trabeculoplasty) or eye drops. Conventional surgery for glaucoma and the gold standard is known as trabeculectomy with mitomycin C. Other alternative approached include non-penetrating surgery (eg viscocanalostomy). Non-penetrating approaches are not generally as effective as trabeculectomy, and are more time-consuming to perform, and may often require laser to scleral tissue after treatment.

Trabeculectomy can be performed with cataract surgery or alone. Mr Galloway prefers to perform cataract surgery ahead of trabeculectomy in most cases, but this is not always required. Glaucoma surgery is performed in an eye theatre, and generally takes 30 to 45 minutes to complete. It is usually performed under local anaesthetic but can easily be done under general anaesthesia. Local anaesthesia is often preferred as the recovery time is quicker, with a shorter hospital visit. If glaucoma is complex, or there has been recent trauma to the eye, general anaesthesia may be preferred.

How is a trabeculectomy performed?

First, eye drops are put in to numb the eye. Local anaesthetic is then given. This may sting for a few seconds - usually about 10 to 20 seconds only. After that, the eye becomes numb, and the vision remains blurred for several hours as a result. Surgery is performed with you lying down. You may be aware of bright lights during surgery. A small pocket of the surface tissues of the eye is created, and an anti scarring medicine is applied to the outer coat of the eye. Then, a small flap of tissue is fashioned to provide a covering over a miniature (less than 1mm) opening made into the eye. The flap covers the opening and is stitched back down with several sutures. 2 of these sutures may be releasable - allowing the surgeon to remove them later quickly. The releasable sutures are buried under the surface, and also buried within the cornea, so can be left alone without issue if there is no need for removal.

Do's and Dont's after glaucoma surgery

* do not rub or press on the eye.
* use the drops as instructed
* continue with normal light daily activities
* avoid splashing soap, water or anything else into the eye
* wash your hair in the shower avoiding getting water into the eye
* be aware that the vision is often very blurred for a number of weeks
* plan to be off work for 2 weeks
* do not carry out strenuous exercise
* do not drive unless, or until, you are told it is safe to do so

Mitomycin C - used in glaucoma surgery to reduce scarring.

mitomycin

Last Updated on Thursday, 21 January 2010 23:40