What Is Trabeculectomy Surgery?

It was the best of times, it was the worst of times…”  If this well known opening to Charles Dickens’ Tale of Two Cities were to be rewritten as “It was the best of glaucoma surgeries, it was the worst of glaucoma surgeries,…” it would accurately describe trabeculectomy.  Why is it that trabeculectomy is both heralded by glaucoma surgeons as the “gold standard” in glaucoma surgery treatment while at the same time it is feared by well-informed patients as well as regretted by many who have had it done?  How can we reconcile this seeming paradox?
Trabeculectomy, also known as filtering surgery, has been around since 1968.  Clearly it must have great value in the treatment of glaucoma to have survived essentially unchanged for half a century.  As glaucoma surgeries go, it is the most likely surgery to lower the intraocular pressure (IOP) into the low teens, or even below 10mmHg.   Few other glaucoma surgeries can achieve such impressive IOP reduction and none do so as often as trabeculectomy.  However, this comes at great potential cost to the patient.  This cost is not a financial one as nearly every insurance (including Medicaid) covers this surgery.  The cost is in the form of risks, side effects, and post-operative lifestyle limitations.

Trabeculectomy Risks

 
In order to understand good, the bad, and the ugly ↬“The Good, the Bad and the Ugly (1966 film) aspects of trabeculectomy, it is necessary to understand a bit about the surgery itself.  The more common forms of glaucoma are thought to be caused by an obstruction of the eye’s drainage system: trabecular meshwork, Schlemm’s canal, and associated collector channel system.  Thus, if one could effectively bypass the obstruction then fluid could exit the eye and the IOP would be lowered.  Trabeculectomy does exactly that – bypassing the obstruction by creating a fistula (hole) in the wall of the eye (sclera) that allows fluid to bypass the obstruction. Read more: http://new-glaucoma-treatments.com/trabeculectomy-surgery-glaucoma/#ixzz3ANC70JX1
Source: David Richardson, MD
 

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