First of all, it can be performed in all types of glaucoma. However, alternative methods of treating glaucoma (topical medication, SLT, etc.) are preferable to surgery. When other methods of treatment fail to regulate glaucoma, then surgery offers a solution to the problem.

The surgery is usually performed under local anesthesia (eye drops and parabulbar anesthesia) and with mild sedation. Therefore, the patient is awake, but does not feel pain or stress during the surgery.

The duration of the operation by an experienced specialized surgeon lasts about one hour in total. After the end of the operation, detailed instructions are given and the patient can return home after a short time of surgery.

It is normal for vision to be blurry and for there to be mild pain after the operation. Blurred vision can last from one to two weeks after the operation and then gradually improves. It may take up to three months for the eye to fully recover. The discomfort after the operation is due in part to the surgical procedures themselves, but also to the stitches that are placed in the eye (which are easily removed in the doctor’s office, under local anesthesia, with eye drops 2-3 weeks after the operation). After the stitches are removed, the patient feels better.

You will be given eye drops to instill into the operated eye at regular intervals throughout the day as directed by your surgeon. You will need to see your surgeon once a week for the first month (or more often if your intraocular pressure is very high or very low). During this time, your stitches will be removed or your medication will be adjusted as needed. Sometimes, a more invasive procedure may be required by your surgeon, such as opening the sutures in the infiltrating ampulla (needling) under local anesthesia.

Vigorous exercise should be avoided in the initial postoperative period, including swimming, running, sports involving intense movement or contact. Bending over should also be avoided. Television and reading are permitted, as well as flying by plane.

Although this answer depends on several factors, such as the nature of the job and the state of vision and pressure in the operated eye, typically for someone working in an office, 2 weeks of leave is required. If the work is heavy and the work environment is not clean, then a month or more of absence from work duties may be required.

It should be noted that success for this operation is considered to be the control of intraocular pressure and its maintenance at low levels without the need for additional treatment. Success rates depend on many factors such as the type of glaucoma, previous history, race, age, etc. One study showed that 90% of patients who had undergone trabeculectomy had controlled pressure 20 years postoperatively. Around 15-20% will need some kind of operation again during their lifetime to control intraocular pressure.

Serious complications are rare and can occur if the intraocular pressure drops too low or too quickly in the initial postoperative period. Very low intraocular pressure can lead to bleeding in the back of the eye (choroidal hemorrhage). The patient usually does not feel pain in this case, but may experience mild pain or a throbbing sensation in the eye. Therefore, if you notice severe blurring or distortion in your vision or something like a moving curtain in your field of vision, you need to visit your surgeon immediately so that the complication can be treated quickly and effectively. Other complications from trabeculectomy are infection, discomfort and cataracts. The possibility of infection after surgery, with proper use of the eye drops that have been given is very rare. In general, the risk of postoperative infection is slightly increased during the patient’s lifetime, but with appropriate treatment and intervention by the ophthalmologist, serious and vision-threatening infection is avoided. A feeling of discomfort can be caused by the enlargement of the infiltrating ampulla under the eyelid, which can lift it or make it droopy or even cause dry eye (due to the fact that it interferes with the proper functioning of the tear film). This is something that the ophthalmologist can even treat surgically if necessary (to reduce the infiltrating ampulla). Finally, cataracts are another complication easily treated by an experienced ophthalmologist surgeon.

In general, in modern ophthalmology, we avoid operating simultaneously for different eye diseases, unless it is made necessary by other factors. We usually choose to operate on the cataract first. We do this because cataract surgery becomes more difficult after a trabeculectomy and there is a possibility that the surgical result of the second one may be spoiled after the cataract surgery. Also, cataract surgery itself reduces intraocular pressure (i.e. it functions to a certain extent as an antiglaucoma surgery) and another antiglaucoma surgery may not be needed. However, if the intraocular pressure after cataract removal has not decreased to satisfactory levels, then trabeculectomy will also be needed, which can be performed shortly after the cataract surgery.