A trabeculotomy is a specialized surgical procedure performed on the eye. It involves creating an opening in the eye’s natural drainage system to facilitate the outflow of fluid. This microsurgical intervention aims to reduce pressure within the eye.
Addressing Glaucoma
Trabeculotomy is primarily performed to treat glaucoma, a condition characterized by elevated pressure inside the eye, known as intraocular pressure (IOP). This increased pressure can damage the optic nerve, which transmits visual information from the eye to the brain, potentially leading to vision loss. The eye continuously produces a clear fluid called aqueous humor, which normally drains out through a mesh-like tissue called the trabecular meshwork. When this drainage system is blocked or not functioning correctly, the fluid builds up, causing pressure to rise.
The procedure is a common treatment option for pediatric or congenital glaucoma, where children are born with or develop glaucoma at a young age, often due to developmental abnormalities in the eye’s drainage angle. In these cases, trabeculotomy helps by directly opening the blocked drainage pathways, allowing the aqueous humor to flow out more freely. It is also used in certain adult glaucoma types, such as early-stage exfoliation glaucoma and steroid-induced glaucoma.
The Surgical Process
The trabeculotomy procedure is a microsurgery performed under anesthesia, which can be local or general. For children, general anesthesia is used to ensure they are completely asleep during the operation. The surgeon begins by gently holding the eye open with an eyelid speculum to provide a clear view of the surgical area.
A small incision is then carefully made in the conjunctiva, the transparent membrane covering the white part of the eye, and the sclera, the white outer layer of the eyeball. Through this incision, the surgeon precisely identifies Schlemm’s canal, a circular channel within the eye’s drainage system. A specialized instrument, called a trabeculotome, is then inserted into this canal to gently break open the trabecular meshwork, the spongy tissue that normally filters fluid out of the eye. This action creates a new, direct pathway for the aqueous humor to drain, bypassing the blocked natural drainage system. After the drainage pathway is successfully opened, the scleral and conjunctival flaps are carefully closed with dissolvable stitches, and a protective eye patch or shield is placed over the eye.
Before and After the Procedure
Preparation for a trabeculotomy involves pre-operative assessments. Patients may be instructed to fast for a certain period before surgery. It is important to discuss all current medications, including blood thinners, with the doctor, as some may need to be adjusted or temporarily stopped prior to the procedure to reduce the risk of bleeding. Patients should also make arrangements for someone to drive them home after the surgery and stay with them for the first night, as vision may be blurry and discomfort can be present.
Immediately following the procedure, patients can expect some discomfort, redness, and irritation in the operated eye. Blurry vision is common for several weeks after surgery due to swelling and medications used during the procedure. Eye drops, usually antibiotics and anti-inflammatory medications, will be prescribed to prevent infection and reduce swelling, and these must be used exactly as instructed.
Patients are advised to avoid rubbing or putting pressure on the eye, strenuous activities, heavy lifting, and bending over for several weeks to prevent increased eye pressure and promote proper healing. A protective eye shield is recommended for use at night for at least a week to prevent accidental rubbing while sleeping. Follow-up appointments with the ophthalmologist are frequent in the initial weeks to monitor healing and eye pressure.
Expected Results and Important Considerations
The primary goal of trabeculotomy is to lower intraocular pressure and prevent further damage to the optic nerve. For instance, studies on pediatric cases have shown success rates of over 80% at one year for children who did not have glaucoma at birth. In adult cases, qualified surgical success, defined as controlled IOP within a target range (e.g., between 5 mmHg and 18 mmHg) with or without additional medication, can be achieved in approximately 73% of eyes after a mean follow-up of six years.
Ongoing monitoring by an ophthalmologist is necessary after trabeculotomy to ensure the long-term effectiveness of the procedure. While the surgery successfully controls eye pressure, some patients, particularly those with pediatric glaucoma, may require additional treatments or even repeat surgeries in the future if pressure begins to rise again. Adherence to prescribed eye drops and activity restrictions during the recovery period is crucial for optimal healing and to minimize complications like scarring, which can impede fluid drainage and affect the long-term success of the surgery. The procedure aims to prevent further vision loss, but it does not restore vision that has already been lost due to glaucoma.