Trabeculectomy (Trab)

This surgery creates a new drainage system on the white part of the eye under the upper eyelid, using its own natural tissue without any implant.  This drainage system allows pressure to be released from the eye in a controlled fashion.  The amount of drainage can be adjusted after surgery to ensure the pressure is in the ideal range for the eye.  The draining fluid goes into a space we call the “bleb”, which is between the white of the eye (the sclera) and the clear membrane that covers it (the conjunctiva).  It is normal for the area under the upper eyelid to look slightly puffy after a Trab, especially at first.

  • Why is a Trab performed?

    Glaucoma is damage to the optic nerve caused by pressure.  Sometimes the pressure cannot be adequately managed with drops, laser, or other procedures.  A Trab, once healed and adjusted, can keep the pressure under control without daily medication for most patients (about 90%), and stop the permanent loss of vision caused by glaucoma. 

  • What is the surgery like for the patient?

    A Trab takes about 30-40 minutes in the operating room typically.  An anesthesiologist gives IV sedation and the eye is numbed thoroughly with drops to ensure that it is a painless and comfortable experience.  General anesthesia and a breathing tube are not typically necessary, making for a faster recovery.

  • What happens after surgery?

    Multiple follow up visits are needed to ensure proper function of a Trab.  Usually this is on day 1 after surgery, week 1, and then 1-2 weeks later, and then the interval can be extended if appropriate.  Adjustments to flow are often done with a quick, painless laser treatment at some of these visits.  Some eyes require more follow up than others.  The eye is very fragile at first after a Trab is done, and it is critical to avoid strenuous activity until your doctor says it is safe.  This means that patients must avoid lifting more than 5 lbs, bending the head below the heart, push-ups, sit-ups, yoga, or any other activity that puts pressure around the eye or strains the core muscles.  Once the eye has healed adequately (usually 1-2 weeks), it becomes safe to resume normal activity.

  • What are the risks of a Trab?

    As with any eye surgery, trabeculectomy carries the risk of bleeding, infection, loss of vision, or need for further treatment.  Specifically with this surgery, the key risks are that the pressure may go too low (which impairs the vision), the surgery may scar down and stop working (which may require further procedures), and although very rare, infection can happen many years later.  This is important to know about, not because it is likely, but so that it can be evaluated and treated promptly if the eye becomes red and painful at any stage after surgery.

  • Who is a Trab right for?

    Patients who do well with a Trab often fall into some or all of these categories:  they have moderate to severe glaucoma, they need good pressure control off medication, they are highly motivated to do what it takes to stop their glaucoma from progressing, and they are able to follow strict activity precautions for several weeks.  A Trab is a big investment of time, effort, and energy, with the potential for significant benefit: preventing vision loss in the long term.