66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

Name of the Procedure:

Trabeculectomy with Antifibrotic Agents (Fistulization of Sclera for Glaucoma)

Summary

This surgical procedure, known as trabeculectomy, involves creating a small hole in the sclera (the white part of the eye) to improve drainage of excess eye fluid. This helps reduce intraocular pressure for patients suffering from glaucoma, especially when previous ocular surgery or trauma has caused scarring. The procedure may include the injection of antifibrotic agents to prevent scar tissue formation that could block fluid drainage.

Purpose

The main goal of a trabeculectomy is to reduce elevated intraocular pressure (IOP) caused by glaucoma, a condition characterized by damage to the optic nerve due to fluid buildup. Lowering IOP can prevent further vision loss and preserve what remains of the patient’s eyesight.

Indications

• Elevated intraocular pressure unresponsive to medication
• Progressive optic nerve damage due to glaucoma
• Scar tissue from prior ocular surgeries or trauma making other treatments ineffective
• Failed filtering surgeries

Preparation

• Patients may be advised to stop certain medications (e.g., blood thinners) beforehand.
• Diagnostic assessments such as visual field tests and optic nerve imaging.
• Fasting may be required for a few hours before the procedure.
• Administration of eye drops to prepare the eye for surgery.

Procedure Description

1. The patient is given local anesthesia to numb the eye area.
2. A small incision is made in the conjunctiva (the outer layer of the eye).
3. A flap is created in the sclera to access the deeper eye tissues.
4. A small hole is made in the sclera to allow fluid drainage.
5. Antifibrotic agents (like Mitomycin-C) are injected or applied to the surgical site to prevent scar tissue formation.
6. The scleral flap is sutured back in place but left slightly loose to allow fluid passage.
7. The conjunctival incision is then closed with sutures.

Duration

The procedure typically takes about 45 to 60 minutes.

Setting

This surgery is usually performed in a hospital or an outpatient surgical center.

Personnel

• Ophthalmic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses or technicians

Risks and Complications

• Infection
• Bleeding
• Scarring that may block fluid drainage
• Hypotony (excessively low intraocular pressure)
• Vision loss (rare)
• Need for additional surgeries

Benefits

• Effective reduction of intraocular pressure
• Preservation of remaining vision
• Delayed or prevented progression of glaucoma-related vision loss
• Reduced reliance on glaucoma medications

Recovery

• Patients are usually prescribed antibiotic and anti-inflammatory eye drops post-surgery.
• Physical activities may be restricted for several weeks to avoid pressure on the eye.
• Regular follow-up appointments are required to monitor IOP and healing.
• Full recovery typically takes a few weeks to a few months.

Alternatives

• Medications (eye drops to lower IOP)
• Laser therapy (Selective Laser Trabeculoplasty)
• Minimally invasive glaucoma surgeries (e.g., iStent, Trabectome)
• Each alternative varies in effectiveness, risks, and recovery time, with surgical options generally providing a more permanent solution.

Patient Experience

During the procedure, the patient will be awake but under local anesthesia, feeling little to no pain. Some pressure or mild discomfort may be experienced. Post-operatively, there may be mild pain, redness, and blurred vision, which are managed with medications. Most discomfort subsides within a few days, and vision stabilizes as the eye heals.