• Leaflet Trabeculectomy
• for patients
• for professionals
• post operative assessments
  
  
• how to grade blebs

• What is glaucoma?
  • Text
  • Animation of glaucoma
  • Professionals: notes
  • SLT laser
• Angle closure glaucoma & narrow angle glaucoma / laser iridotomies
  • Animation of laser iridotomy
  • Chronic narrow angle glaucoma
  • Text
  • Professionals: notes
• Internat. Glaucoma Association
• Intraocular hypertension
• Low tension glaucoma
• Pre-perimetric glaucoma
• Visual field testing
• Drops & tablets for glaucoma
• Animations etc
  • Glaucoma
  • Laser iridotomy
  • Trabeculectomy
  • Rubeotic glaucoma
  • Progression model
  • SLT laser
• Rubeotic glaucoma
  • Text
  • Rubeotic glaucoma animation
  • Professionals: notes
• Students: Cases
  • Case 1
  • Case 2
  • Case 3
  • Case 4
  • Case 5
  • Case 6
  • Case 5
  • Case 8
  • Case 9
  • Case 10
  • Case 11
• Pseudoexfoliation..link
• Pigmentary glaucoma ..link
• Trabeculectomy
  • Text
  • Animation
  • Audit
    • 2006 with photos
    • 2008
• More technical
  • Corneal thickness & IOP
  • Hypotony
  • Arcuate scotomas ..glaucoma?
• Glaucoma letters
• Glaucoma photos (professionals)

Trabeculectomy is well described here, here , This page just has a few notes, with an animation here. Leaflet Trabeculectomy. Some wonderful videos and other information here

The pages above  describe the operation, but there are important details to remember.the operation creates a valve that leads fluid out of your eye. If this valve blocks as part of the healling process, anti-healing treatment to open the valve up is often needed. This will help to stop closing again. The anti-healing treatment often has to be repeated.

• nearly all patients need antihealing treatment.

• after the operation your sight may not be quite as clear, and there are risks as described on the pages with links above;

• the operation is just the first stage; for instance

  1. the first day after your operation, if the pressure is very low, the steroid drops are stopped for a few days. For instance, if the 'AC' is deep, and the pressure 0, stop drops for 2 days (as an example).

  2. 1-2 weeks after the operation, if the pressure is >14mmHg, you usually need the releasable suture releasing

  3. a pressure of 10-14 is ideal at this stage (severe glaucoma needs a lower pressure)

  4. patients are often seen every week for a while to ensure the presure stays at this required level

  5. in the days after the operation patients with too much leak and a shallow anterior chamber may need further surgery to seal the leak.

• after the operation, steroid drops, antibiotic drops, and drops to dilate the pupil are often needed.

• always bring the drops with you to the clinic, as the dose will be adjusted etc

• in the weeks after the operation, if the wound becomes very red extra steroid drops may be needed (the redness is a sign of an over-active healing process)

• if the pressure rises, anti-healing injections will be offered

• you should not go on holiday abroad for 3 months after your operation (advice changes depending on how severe the glaucoma is, etc)

• some ophthalmologists recommend no swimming after the operation in the years after surgery, but others feel swimming is safe once the eye has recovered after the operation (accepting there is a very small risk of problems, but that the benefits outweigh the risks)

• how to grade blebs

• post-op red blebs need treatment (steroids, 5FU etc)...must get the bleb white

• a small 'ring of steel' bleb has a much higher risk of infection...consider needling these

• it is possible/helpful to needle old blebs, as long as they are not completely flat. 5FU will be needed for the procedure.

1st day post op mitomycin trab

• check iop
• look at
  • bleb
  • AC
  • 2% fluorescein to see if bleb leaking
• if leaking, mreduce steroid drops

1st week

• if > 14 and bleb flat and not leaking, gentle pressure behind bleb
• check iop
• look at
  • bleb
  • AC
  • 2% fluorescein to see if bleb leaking
• if very red, increase steroid drops
• if leaking, reduce steroid drops

2nd week

• if > 14 and bleb flat and not leaking, gentle pressure behind bleb
• check iop
• look at
  • bleb
  • AC
  • 2% fluorescein to see if bleb leaking
• if > 14 and bleb flat and not leaking, gentle pressure behind bleb
• if very red, increase steroid drops
• if leaking, mreduce steroid drops

1 month

• also remove INTERRUPTED sutures
• releasable sutures only to be removed if IOP high