Trabeculectomy is the most widely used surgery to treat glaucoma worldwide.

During surgery an alternative route is created for the aqueous humour to drain into the systemic circulation, allowing it to be eliminated by the subconjunctival blood vessels, aqueous veins and lymphatic vessels.

Trabeculectomy is usually performed under local anaesthesia. A fistula is created from the anterior chamber to below the conjunctiva through the sclera - trabecular meshwork - allowing the aqueous humour to drain. A subconjunctival filtration bubble is formed.

The success rate of this surgery is high, although in some cases additional medical therapy is required.

O glaucoma is an optic neuropathy which, without proper treatment, can lead to a loss of visual field and, in the last instance, can lead to irreversible blindness. One of the risk factors is the increase in intraocular pressure, and on which we can act in order to delay or even stop the progression of the pathology.

Treatment for glaucoma aims to reduce intraocular pressure. Either by decreasing the production of medical aqueous humour or by increasing the drainage flow of aqueous humour, in trabeculectomy.

When to have glaucoma surgery glaucoma surgery?

Surgical treatment of glaucoma is indicated in the following situations:

• It is not possible to lower the eye pressure to satisfactory values with maximum medical therapy or laser;
• Adherence to medical therapy is low;
• In a patient with marked hypotension;
• Existence of allergy to the eye drops used;
• There is a progression of glaucomatous lesions even when the pressure is apparently controlled despite maximum tolerated medical treatment.

In glaucoma congenital glaucoma, treatment is essentially surgical.

Before the surgical procedure, the patient must be informed that the objective will not be to restore his vision, but to control intraocular pressure. In a pre-operative evaluation, the patient's previous medical history is important, if there are problems related to blood coagulation or systemic arterial hypertension, the risk of complications may increase.

Several complications may occur in the postoperative period, which are not directly related to the surgical technique used. One of the possible complications is haemorrhage due to conjunctival anaesthesia or surgical handling, rupture of the conjunctival filtration bubble, loss of aqueous humour due to suture dehiscence, atalamia (non-existent anterior chamber after surgery), choroidal haemorrhage, endophthalmitis cataract secondary, among other less frequent ones.

In order to minimise some risks, you should follow your doctor's recommendations to the letter. 

In general, recovery from a trabeculectomy is quick and takes about two weeks. It is recommended that the patient should avoid physical exertion, carrying heavy objects, putting the head down, scratching or rubbing the eye and sleeping on the opposite side of the operated eye.

Normally, after this type of surgery, in the first 6 months, the patient is re-evaluated every month. As glaucoma is a chronic and evolutive disease, it may be necessary to reintroduce eye drops or even other surgeries.