Glaucoma surgery (Trabeculectomy) at Edinburgh Hospital

What happens during glaucoma surgery (trabeculectomy)?

Before surgery

Make sure your healthcare team knows about all the medication you take and follow their advice. This includes all blood-thinning medication as well as herbal and complementary remedies, dietary supplements, and medication you can buy over the counter.

If the operation is performed under a local anaesthetic, you will need to lie still and flat during the operation. If you cannot lie still and flat, let your surgeon know.

Your face will be covered with a cloth to allow your surgeon to work on a clean surface. Air will be blown gently towards your nose. If you are claustrophobic, let your surgeon know.

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

The day of surgery

The healthcare team will carry out a number of checks to make sure you have the operation you came in for and on the correct side. You can help by confirming to your surgeon and the healthcare team your name and the operation you are having. Various anaesthetic techniques are possible, including a general anaesthetic or a local anaesthetic that is injected around your eye to numb it. Your anaesthetist or surgeon will discuss the options with you.

During surgery

Glaucoma surgery involves draining some of the fluid in your eye to lower the pressure. Your surgeon will make a small draining hole in the lining of the white of your eye. The fluid will drain out into a space in the outer lining of your eye and collect just under your eyelid.

Your surgeon may treat the surface of your eye (conjunctiva) with anti-scarring medication to improve the chance of the long-term success of the operation.

The operation usually takes 45 to 75 minutes.

Recovery from glaucoma surgery (Trabeculectomy)

After the operation you will be transferred to the recovery area and then to the ward or day-case unit. You should be able to go home after a few hours. However, your doctor may recommend that you stay overnight.

If you do go home the same day, you will need to arrange for some to take you home in a car or taxi and stay with you for at least 24 hours. Be near a telephone in case of an emergency.

Pain is usually only mild and easily controlled with simple painkillers such as paracetamol. You may feel pressure or mild discomfort. If you are in severe pain, let your surgeon know as this is unusual.

Your surgeon will need to check your eye the day after the operation. They will see you several times in clinic during the first few weeks and may perform minor adjustments.

Stitches may be loosened or removed so the fluid can drain better. Your surgeon may massage the area around the draining hole, inject anti-scarring medication into the surface of your eye and scrape away any scar tissue that may be blocking the hole. These procedures are usually painless and are performed after your eye has been numbed using local-anaesthetic eye drops.

Returning to normal activities

Do not drive, operate machinery or do any potentially dangerous activities (this includes cooking) for at least 24 hours and not until you have fully recovered feeling, movement and co-ordination. If you had a general anaesthetic or sedation, you should also not sign legal documents or drink alcohol for at least 24 hours.

Your surgeon will tell you when you can return to normal activities. Most people will need about 2 weeks off work.

For the first 4-6 weeks do not do activities, such as swimming, that will expose your eye to infection and avoid dusty environments. It is important to look after your eye as you are told, to reduce the risk of complications.

Do not swim, lift anything heavy or bend so your head is below your waist until you have checked with your surgeon.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

Do not drive until you are confident about controlling your vehicle and always check your insurance policy and with your doctor.

Most people make a good recovery from the operation, with their glaucoma under better control.

Risks of glaucoma surgery (trabeculectomy)?

• Heavy bleeding inside your eye during surgery
• Bleeding at the front of your eye
• Inflammation in your other eye
• Too much fluid draining
• Sharp rise in eye pressure
• Developing a cataract
• Reduced vision over time caused by glaucoma
• Failure of the operation

Alternative treatments

You can use eye drops to lower the pressure. If they do not work, surgery is usually recommended.

Laser treatment may be suitable for you but is often less effective than surgery. If appropriate, your surgeon will discuss laser treatment with you.