Name of the Procedure:

Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery

Summary

This procedure, commonly known as trabeculectomy, is a surgical intervention performed on the eye to relieve intraocular pressure in patients with glaucoma. It involves creating a small hole in the sclera (the white part of the eye) to allow excess fluid to drain, thereby reducing pressure on the optic nerve.

Purpose

The procedure is designed to treat glaucoma, a condition characterized by increased pressure within the eye that can lead to optic nerve damage and vision loss. The goal is to reduce intraocular pressure and thereby prevent further damage to the optic nerve, preserving the patient's vision.

Indications

Trabeculectomy is typically recommended for patients with glaucoma who:

• Have not responded adequately to medication or laser therapy.
• Are experiencing progressive optic nerve damage.
• Have high intraocular pressure that cannot be controlled by other means.

Preparation

Patients may need to:

• Undergo a comprehensive eye exam and other preoperative tests.
• Adjust medication schedules as advised by their doctor.
• Arrange for transportation to and from the surgical site, as they may not be able to drive post-procedure.

Procedure Description

1. The patient will receive local anesthesia to numb the eye, and sometimes a mild sedative to help relax.
2. The surgeon will create a small flap in the sclera.
3. A tiny hole is made under this flap, through which the aqueous humor (fluid inside the eye) can drain.
4. The scleral flap, along with a portion of the conjunctiva (the outer membrane of the eye), is sutured back, forming a new drainage path.
5. This allows the fluid to bypass the clogged trabecular meshwork, reducing intraocular pressure.

Duration

The procedure typically takes about 45 to 60 minutes.

Setting

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

Personnel

The procedure involves:

• An ophthalmic surgeon.
• An anesthesiologist or a nurse anesthetist.
• Surgical nurses and support staff.

Risks and Complications

Common risks include:

• Infection.
• Bleeding.
• Swelling or inflammation.
• Scarring that might obstruct fluid drainage. Rare but serious complications can include:
• Severe vision loss.
• Hypotony (too low intraocular pressure).
• Endophthalmitis (a severe eye infection).

Benefits

The main benefit is the significant reduction in intraocular pressure, which helps to prevent further optic nerve damage and vision loss. Many patients may notice an improvement in symptoms within a few weeks post-surgery.

Recovery

• Patients will need to use antibiotic and anti-inflammatory eye drops for several weeks.
• It's crucial to avoid strenuous activities and heavy lifting.
• Follow-up appointments are necessary to monitor eye pressure and healing.
• Full recovery generally takes several weeks to a few months.

Alternatives

Alternative treatments include:

• Medications (eye drops or oral drugs) to reduce eye pressure.
• Laser therapy, such as laser trabeculoplasty. Each alternative has its own pros and cons, with medications being less invasive but sometimes less effective, and laser treatments posing fewer risks but with varying success rates.

Patient Experience

During the procedure, patients might feel pressure but should not experience pain due to anesthesia. Post-procedure, some discomfort and mild pain are normal and can be managed with pain relief medications. Patients may experience blurred vision or sensitivity to light during the recovery period.