Glaucoma Surgery
Glaucoma surgery includes iris procedures (surgical iridectomy), angle procedures (goniotomy, trabeculotomy), filtration procedures (trabeculectomy, deep sclerectomy), minimally invasive glaucoma surgery (MIGS) and setons (tube drainage surgery).
Goniotomy and trabeculotomy are restricted to congenital glaucoma (Glaucoma in children).
In adult Glaucoma, the commonest operation and gold standard is TRABECULECTOMY with or without augmentation. Augmentation is with antifibrotics e.g Mitomycin C, and this reduces scarring which will in turn reduce the risk of filtration failure.
Artificial drainage tubes (or setons) require considerable experience and are generally reserved for resistant cases.
TRABECULECTOMY
It is commonly done in most chronic Glaucomas (adult and children).
Basically, a new drainage channel from the anterior chamber to the sub-tenon’s space is created- thereby reducing the intraocular pressure (IOP).
Trabeculectomy is usually performed when medical therapy has failed to achieve adequate control of IOP. However, it may be the first line of treatment if there’s a high risk of Glaucoma progression or if patient aims to be ‘drop-free’.
If you have been scheduled for a Trabeculectomy, the Ophthalmologist will have you sign a Consent form. This means the aim of the operation and possible complications have been explained to you in a language you understand, and you are giving a go-ahead for your Doctor to proceed.
Anaesthesia (topical, peribulbar) is given, so you don’t feel pain. The pupil is not dilated. Rather, Pilocarpine drops may be instilled. The procedure is done in theatre under sterile conditions.
The patient is expected to return to the clinic the next day where the eye pad will be removed, and the eye cleaned and examined. Post-op medications will be commenced, and subsequent clinic appointment is scheduled. These post-op drops may have to be used for up to 2months or more, depending on the healing process, but will not be as frequent as in the immediate post op period.
