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| My doctor tells me drops and laser treatment have not been enough to keep my intraocular pressure at the right level for my eyes. What's next? |
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When medicines and laser surgeries do not lower eye pressure enough, doctors may recommend a procedure called a trabeculectomy (sometimes called conventional or cutting surgery).
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What is a trabeculectomy?
A tiny drainage hole is made in the sclera (the white part of the eye). The new drainage hole allows fluid to flow out of the eye and helps lower eye pressure. This prevents or reduces damage to the optic nerve.
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Is there pain during the surgery?
In most cases, there is no pain involved. The surgery is usually done with a local anesthetic and relaxing medications. Often a limited type of anesthesia, called intravenous (I.V.) sedation, is used.
In addition, an injection is given around or behind the eye to prevent eye movement. The patient will be relaxed and drowsy and will not experience any pain during surgery.
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What is the success rate?
Most of the related studies document follow-up for a one year period. In those reports, it shows that in older patients, glaucoma filtering surgery is successful in about 70-90% of cases, for at least one year.
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| What's happening when it isn't working anymore?
Occasionally, the surgically-created drainage hole begins to close and the pressure rises again. This happens because the body tries to heal the new opening in the eye, as if the opening were an injury. This rapid healing occurs most often in younger people, because they have a stronger healing system.
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| Can anything be done at this point?
Anti-wound healing drugs, such as mitomycin-C and 5-FU injections, help slow down the healing of the opening. If needed, glaucoma filtering surgery can be done a number of times in the same eye.
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| Do you have to stay in the hospital overnight after a trabeculectomy?
Usually, it's an outpatient procedure, requiring no overnight hospital stay. Your doctor will want to see you the following day to check your pressure, and look for any signs of infection or increase in inflammation.
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How long is the recovery time?
For at least one week after surgery, patients are advised to keep water out of the eye. Most daily activities can be done, however, it is important to avoid driving, reading, bending, and doing any heavy lifting. Since each case is different, patients should check with their doctor for specific advice.
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How will the eye look after surgery? Is there a noticeable scar or redness?
The eye will be red and irritated shortly after surgery, and there may be increased eye tearing or watering. The inner eye fluid flows through the surgically-created hole and forms a small blister-like bump called a bleb. The bleb, usually located on the upper surface of the eye, is covered by the eyelid, and is usually not visible.
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Will vision be changed? Will glaucoma medications still need to be taken?
There may be some vision changes, such as blurred vision, for about six weeks after the surgery. After that time, vision will usually return to the same level it was before surgery.
Vision can sometimes improve after surgery in people who were previously using pilocarpine. When pilocarpine drops are no longer taken, the pupil returns to normal size, allowing more light to enter the eye.
In a few cases, the vision may be worse due to very low pressure, or a wrinkle in the macula (center of the retina) .
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Will my prescription change?
A patient’s glasses or contact lenses may need to be changed after surgery. In most cases, either gas permeable or soft contact lenses may be worn after the trabeculectomy; however there may be fitting problems due to the bleb. Special care is needed to avoid infection of the bleb. Contact lens users need to discuss these problems with their eye doctor before resuming lens wear.
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