Trabeculectomies relieve pressure on the eye, slow down vision loss

By Nick Rees

 Prevent Blindness America estimates that four million Americans have glaucoma but that only half of those with it are aware of it.
 
Approximately 120,000 Americans are blind from glaucoma, the National Institutes of Health reports, which accounts for as much as 12 percent of all blindness cases in the United States. Glaucoma is the second leading cause of blindness in the world, the World Health Organization reports.

To treat glaucoma, doctors can use a procedure known as trabeculectomy to relieve intraocular pressure, which is pressure in the eye on the thick, watery substance that fills the space between the lens and the cornea.

"A trabeculectomy is an incisional surgical procedure wherein an opening is placed within the eye to allow fluid pressure in the eye to drain under the tissues," Dr. Steven Brown, MD, selected as a Chicago Top Doctor by TopTierMD as a top rated ophthalmologist in Chicago, said. "It is a therapy to prevent, slow down or arrest glaucomatous optic nerve damage.

After surgery, Dr. Brown said, it is not uncommon for the patient to experience a slight diminishment in vision.

"The best corrected vision may be diminished by a line or two in a significant number of people," Dr. Brown said. "There also can be an uncomfortable feeling on occasion, but not always."

"Other complications can be infection, late onset infection and what we call dysfunction of the filtration web. The trabeculectomy creates a filtration reservoir, which may disrupt the tear film, become weak or develop leaks."

Additionally, Dr. Brown said, the body might attempt to heal itself around the shunt.

"If the body tries to heal, we use anti-fibrotics and anti-scar tissue medication to combat it," Dr. Brown said. "This is a double-edged sword, however, because we want it to heal a little bit, but not completely."

The overall goal of the surgery is to titrate the pressure in a patient's eye to a level that is safe for the optic nerve.

"It's different for each person and each eye," Dr. Brown said. "My job, as the surgeon, is to assess the risk/reward for the patient with keen insight as to the patient's lifestyle and longevity. Younger individuals may need to have the surgery but the consequences of disrupting their lifestyle may be too great, so there's no real cookbook approach.

"It's really a sign of a surgeon's ability to work with a patient and understand the stage of the glaucoma damage. You don't want to disrupt a young person's life."

Dr. Steven Brown, MD, was selected by TopTierMD as a Chicago Top Doctor and is considered Best in Ophthalmology in Chicago. He specializes in trabeculectomy, phaco and complex cataract surgery.