Name of the Procedure:

Fistulization of Sclera for Glaucoma; Trephination with Iridectomy

Summary

This surgical procedure is designed to treat glaucoma by creating a new drainage pathway in the eye. It involves removing a small piece of tissue from the sclera (the white outer layer of the eyeball) and the iris (the colored part of the eye), which helps to alleviate intraocular pressure.

Purpose

The procedure addresses elevated intraocular pressure caused by glaucoma. The goal is to reduce this pressure to prevent further damage to the optic nerve and preserve vision.

Indications

• Patients with open-angle glaucoma or other types of glaucoma refractory to medical therapy.
• Elevated intraocular pressure that cannot be controlled with medication or laser treatments.
• Progressive damage to the optic nerve and visual field loss.

Preparation

• Patients may be instructed to fast for a few hours before the procedure.
• Certain medications may need to be adjusted or discontinued as advised by a healthcare provider.
• Preoperative assessment including measurements of eye pressure, visual field testing, and a comprehensive eye exam.

Procedure Description

1. The patient is usually given local anesthesia to numb the eye area.
2. A small incision is made in the conjunctiva (the membrane covering the white of the eye).
3. A trephine (a surgical tool for cutting out a cylindrical piece of tissue) is used to create a small hole in the sclera.
4. An iridectomy is performed, removing a small piece of the iris to facilitate fluid drainage.
5. The incision is closed, and the new drainage pathway allows aqueous humor (the fluid in the eye) to bypass the blocked channels, reducing intraocular pressure.

Duration

The procedure typically takes around 30 to 60 minutes.

Setting

This procedure is performed in an operating room within a hospital or an outpatient surgical center.

Personnel

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

Risks and Complications

• Infection.
• Bleeding.
• Hypotony (abnormally low intraocular pressure).
• Cataract formation.
• Vision changes.
• Failure of the new drainage pathway requiring additional surgery.

Benefits

• Significant reduction in intraocular pressure.
• Prevention of further damage to the optic nerve.
• Potential stabilization or improvement of visual field loss.

Recovery

• Patients may need to use antibiotic and anti-inflammatory eye drops.
• Avoid strenuous activities for a few weeks.
• Regular follow-up appointments to monitor eye pressure and healing process.
• Full recovery can take several weeks.

Alternatives

• Medications (eye drops, oral medications).
• Laser therapies (e.g., laser trabeculoplasty).
• Other surgical options (e.g., trabeculectomy, glaucoma drainage devices).
• Each alternative has its own risks, benefits, and suitability depending on the individual patient’s condition.

Patient Experience

• Mild discomfort or irritation in the eye after the procedure.
• Vision may be blurry initially, but this usually improves.
• Pain management with prescribed medications, if necessary.
• It is important to follow postoperative instructions to ensure proper healing and optimal surgical outcome.