Trabeculectomy Surgery for Glaucoma

What Is Trabeculectomy Surgery?

Trabeculectomy surgery is a standard procedure for glaucoma patients whose eye pressure remains uncontrolled with medicines or laser therapy. It involves creating a new drainage passage in the eye that allows excess aqueous humour (fluid inside the eye) to drain under the conjunctiva, the thin membrane covering the eye.

This fluid collects in a small blister-like reservoir called a bleb, located under the upper eyelid. The glaucoma surge, with trabeculectomy, lowers intraocular pressure, slowing or stopping further optic nerve damage. It is one of the most commonly performed glaucoma surgeries worldwide and remains a cornerstone treatment for managing advanced or aggressive glaucoma.

Why Is Trabeculectomy Surgery Needed?

Glaucoma surgery, trabeculectomy, is recommended when other methods to control eye pressure are no longer effective. It may also be necessary if the disease is progressing quickly or the patient is unable to tolerate multiple medications.

Reasons for choosing trabeculectomy eye surgery include:

• Failure of eye drops or laser treatments to adequately control IOP

• Advanced glaucoma threatening vision

• Rapidly worsening optic nerve damage

• Severe or congenital glaucoma cases

By surgically improving fluid drainage, trabeculectomy helps prevent further vision loss, though it cannot restore vision that has been lost.

Trabeculectomy Surgery Steps Explained

Trabeculectomy surgery steps involve creating a new drainage pathway for fluid to safely leave the eye. The entire trabeculectomy procedure usually lasts 45-60 minutes and is performed under peribulbar anasthesia in a hospital setting.

Here’s what happens:

• The eye is numbed with peribulbar anasthesia to prevent discomfort.

• A small flap is made in the sclera (white part of the eye).

• A tiny opening is created under this flap to allow fluid to escape.

• The flap is closed with fine sutures to control the amount of drainage.

• The fluid collects under the conjunctiva, forming a bleb that slowly absorbs the fluid.

This controlled drainage helps maintain healthy pressure within the eye while preventing over-drainage.

What to Expect During Glaucoma Surgery: Trabeculectomy

Pre-Surgery Preparation

Before surgery, patients undergo a series of eye tests, including pressure measurements, visual field tests, and optic nerve imaging. Doctors review medications and may advise stopping certain blood-thinning drugs. These trabeculectomy pre-op instructions ensure safety and accuracy during surgery.

During the Surgery

The trabeculectomy operation is performed under peribulbar anasthesia. Patients are awake but feel no pain. The surgeon uses delicate microsurgical instruments to perform the trabeculectomy procedure steps with precision. The process is gentle and controlled, ensuring optimal drainage while minimising trauma to surrounding tissues.

Recovery After Trabeculectomy Surgery

Post-Surgery Instructions

After surgery, patients are prescribed trabeculectomy eye drops to reduce inflammation and prevent infection. It is important not to rub the eye or apply pressure. 

Doctors may also recommend wearing an eye shield while sleeping. Regular check-ups help monitor healing and eye pressure levels. These steps are essential parts of post-trabeculectomy care.

Returning to Normal Life

During the initial trabeculectomy recovery time, vision may appear blurry, and mild irritation or redness can occur. Most patients resume daily activities within 4-6 weeks, but heavy lifting and strenuous exercise should be avoided during recovery. With proper follow-up, the eye gradually stabilises, and pressure control is maintained long term.

Complications of Trabeculectomy Surgery

While trabeculectomy surgery is generally safe, all surgical procedures carry some risk. Understanding the potential complications of trabeculectomy surgery helps patients prepare and follow care instructions closely.

Common temporary side effects include:

• Redness or mild irritation

• Slight bleeding during or after surgery

• Sensitivity to light

• Fluctuations in eye pressure

Rare trabeculectomy risks may involve:

• Infection or inflammation

• Over-filtration, causing low pressure (hypotony)

• Formation of cataracts over time

• Scar tissue is closing the drainage site

With careful monitoring, most side effects can be effectively managed.

Trabeculectomy Surgery Cost

The trabeculectomy surgery cost varies depending on several factors, including the hospital, surgeon’s experience, and whether post-operative care and medications are included.

Typical cost considerations include:

• Hospital type: Government or charitable hospitals usually cost less than private or speciality centres.

• Surgeon’s expertise: Highly experienced ophthalmologists may charge higher professional fees.

• Follow-up and medication costs: Eye drops and follow-up visits are part of the overall expense.

In India, the cost of trabeculectomy typically ranges from ₹25,000 to ₹60,000. Many health insurance providers cover glaucoma surgery, trabeculectomy, as part of eye care benefits, helping reduce out-of-pocket expenses.

Benefits of Trabeculectomy Surgery

The benefits of trabeculectomy surgery extend beyond just lowering eye pressure. Patients experience improved comfort, better long-term control, and reduced dependency on medications.

Key advantages include:

• Long-term control of intraocular pressure

• Prevention of further optic nerve damage

• Reduce the need for multiple glaucoma eye drops

• Improved quality of life by stabilising vision

When performed at the right time, trabeculectomy provides excellent outcomes and significantly slows glaucoma progression.

How to Prepare for Trabeculectomy Surgery

Proper trabeculectomy surgery preparation helps ensure a safe and smooth operation. Patients should:

• Share their full medical history and medications with the doctor

• Avoid blood-thinning medicines like aspirin if advised

• Arrange for transport after the procedure

• Follow fasting or medication instructions provided by the surgeon

Following this pre-op trabeculectomy checklist helps reduce risks and improve surgical outcomes.

Conclusion: Is Trabeculectomy Surgery the Right Option?

Trabeculectomy surgery is a proven and highly effective option for controlling intraocular pressure when other treatments fail. It protects remaining vision, reduces reliance on daily medication, and offers lasting relief for many glaucoma patients. While it cannot restore lost sight, it prevents further deterioration and safeguards vision in the long term.

Patients should discuss with their ophthalmologist whether trabeculectomy is the most suitable treatment for their condition, to ensure an informed and confident decision about their eye health.