Trabeculectomy

Definition

Trabeculectomy is a surgical procedure that removes part of the trabeculum in the eye to relieve pressure caused by glaucoma.

Purpose

Glaucoma is a disease that injures the optic nerve, causing progressive loss of vision. Presently, glaucoma is a major cause of blindness in the United States If caught early, glaucoma-related blindness is easily prevented, However, since it does not produce symptoms until late in its cycle, periodic tests for the disease are necessary.

Glaucoma is usually associated with an increase in the pressure inside the eye. This increase occurs in front of the iris in a fluid called the aqueous humor. Aqueous humor is supposed to exit through tiny channels between the iris and the cornea, in an area called the trabeculum. When the trabeculum is blocked, pressure from the build up of aqueous humor either increases rapidly with considerable pain and redness, or, as in most cases, the pressure builds slowly with no symptoms until much of the vision is lost. Trabeculectomy is the last treatment employed for either type of glaucoma. It is used only after medications and laser trabeculoplasty (less invasive procedure that uses a laser to open the blocked trabeculum) have failed to alleviate the pressure.

Description

A trabeculectomy involves removing a tiny piece of the eyeball right at the place where the cornea connects to the sclera (the white part), and creating a flap to allow fluid to escape the anterior chamber without deflating the eye. Along with that tiny piece of cornea and sclera comes a piece of the iris. The whole area is called the trabeculum. Fluid can then flow out onto the surface of the eye and be absorbed by the conjunctiva, the transparent membrane that lines the sclera and the eyelids. Sometimes, an additional piece is taken out of the iris so that anterior chamber fluid can also flow backward into the vitreous part of the eye. This procedure is called an iridectomy.

Preparation

The procedure and its benefits and possible complications are fully explained. Antiglaucoma drugs are prescribed before surgery. Added pressure on the eye caused from coughing or sneezing should be avoided.

Aftercare

Eye drops, and perhaps patching, will be needed until the eye is healed. The pressure inside the eye will still be monitored. Immediately following the procedure, the patient may experience blurred vision.

Risks

Infection and bleeding are risks of any surgery. Scarring can cause the drainage to stop. A third of patients with trabeculectomies will develop cataracts.

BOOKS

General Ophthalmology. 13th ed. Ed. Daniel Vaughan. Stamford: Appleton & Lange, 1993.

Sardegna, Jill, and T. Paul Otis. The Encyclopedia of Blindness and Vision Impairment. New York: Facts on File, Inc., 1990.

J. Ricker Polsdorfer, MD

KEY TERMS

Cornea—Transparent film that covers the iris and pupil.

Iris—Colored part of the eye, which is suspended in aqueous humor and perforated by the pupil.

Sclera—White, outer coating of the eyeball.

Trabeculoplasty—Laser surgery that creates perforations in the trabeculum, to drain built up aqueous humor and relieve pressure.

Trabeculum—Tissue that is a drainage point for aqueous humor in the eye.