Name of the Procedure:

Trabeculotomy ab externo (also known as external trabeculotomy or ab externo trabeculotomy)

Summary

Trabeculotomy ab externo is a surgical procedure designed to treat glaucoma, a condition that leads to increased pressure in the eye. The surgeon creates an opening in the eye's drainage system to help fluid (aqueous humor) drain more effectively, thereby reducing intraocular pressure (IOP).

Purpose

Trabeculotomy ab externo aims to lower intraocular pressure in patients with glaucoma to prevent damage to the optic nerve and preserve vision. By improving fluid drainage from the eye, the procedure helps to control and manage glaucoma symptoms.

Indications

• Patients with primary congenital glaucoma.
• Those with uncontrolled intraocular pressure despite maximum tolerated medical therapy.
• Specific types of glaucoma, such as open-angle or angle-closure glaucoma, when other treatments are ineffective.

Preparation

• Patients may be required to fast for a specific period before the procedure.
• Medications may need to be adjusted or temporarily discontinued, as advised by the doctor.
• Pre-procedure assessments, including eye examinations and diagnostic tests like gonioscopy and visual field testing, are necessary.

Procedure Description

1. The patient is given local anesthesia to numb the eye, and sedation may be administered for comfort.
2. A small incision is made on the eye's conjunctiva (the clear tissue covering the white part of the eye).
3. The surgeon accesses the trabecular meshwork, the eye's drainage system, from the outside (ab externo).
4. A small opening is created in the trabecular meshwork to allow fluid to drain out more effectively.
5. The incision is then closed with sutures.
6. An eye patch may be applied to protect the eye post-surgery.

Duration

The procedure typically takes about 30 to 60 minutes.

Setting

Trabeculotomy ab externo is usually performed in a hospital or outpatient surgical center.

Personnel

• Ophthalmic surgeon
• Anesthesiologist or sedation nurse
• Surgical nurses and assistants

Risks and Complications

• Infection
• Bleeding
• Swelling or inflammation
• Temporary or permanent vision changes
• Rarely, damage to the eye structures
• Scarring, which could affect the success of the procedure

Benefits

• Reduction in intraocular pressure
• Prevention of further optic nerve damage
• Preservation of vision
• Improvements in quality of life due to better-managed glaucoma

Recovery

• Patients may need to use prescribed antibiotic and anti-inflammatory eye drops.
• Follow-up appointments are necessary to monitor intraocular pressure and overall eye health.
• Recovery time varies; most patients can resume normal activities within a few days to a week but must avoid strenuous activities for a few weeks.

Alternatives

• Medications (e.g., eye drops to reduce intraocular pressure)
• Laser therapy (e.g., laser trabeculoplasty)
• Other surgical options (e.g., trabeculectomy or shunt surgery)
• The choice of treatment depends on individual patient factors and the stage of glaucoma.

Patient Experience

• Mild discomfort or a scratchy sensation in the eye post-surgery.
• Temporary blurry vision or light sensitivity, which improves over time.
• Pain management typically involves over-the-counter pain relievers, and comfort measures include eye patches or shields to protect the eye during recovery.