Bill’s Laser Iridotomy didn’t work, the pressure is still way too high, so in July the doctor is going to try something else. He told Bill that he wasn’t going to let him lose his sight. I don’t really think that’s something you can make a promise about, but he was trying to be reassuring. He sounds like he wants to try several different things before they do actual eye surgery.
He gave us a print out which I posted below for those that have glaucoma that might be facing this same type of surgery down the road. We hope it wont come to that, but you do what you have to. Have a great weekend.
Trabeculectomy & Sclerostomy Filtering Microsurgery
What is filtering microsurgery? In glaucoma, the eye’s inner fluid pressure can build up and damage the optic nerve, the nerve that carries visual pictures to the brain. Damage to the optic nerve can lead to vision loss. When medicines and laser surgeries do not lower pressure enough, eye doctors may recommend a procedure called filtering microsurgery (sometimes called conventional or cutting surgery).
In filtering microsurgery, a tiny drainage hole is made in the sclera (the white part of the eye) in a procedure called a trabeculectomy or a sclerostomy. The new drainage hole allows fluid to flow out of the eye and helps lower the eye pressure. This prevents or reduces damage to the optic nerve.
How does the eye doctor determine if filtering surgery is needed? Often, laser surgery is recommended before filtering microsurgery, unless the eye pressure is very high or the optic nerve is badly damaged. During laser surgery, a tiny but powerful beam of light is used to make several small scars in the eye’s trabecular meshwork (the eye’s drainage system). The scars will help increase the flow of fluid out of the eye.
When laser surgery does not successfully lower eye pressure or the pressure lowering effects wear off, the doctor may recommend filtering rmcrosurgery . Is there pain during microsurgery? In most cases, there is no pain involved. The surgery is usually done with a local anesthetic and relaxing medications. Often a limited type of anesthesia, called intravenous (LV.) sedation, is used.
In addition, an injection is given around or behind the eye to prevent eye movement. This injection is not painful when LV. sedation is used first. The patient will be relaxed and drowsy and will not experience any pain during surgery. What is the success rate? Most of the related studies document follow-up for a one year period. In those reports, it shows that in older patients, glaucoma filtering surgery is successful in about 70-90% of cases, for at least one year.
Occasionally, the surgically-created drainage hole begins to close and the pressure rises again. This happens because the body tries to heal the new opening in the eye, as if the opening were an injury. This rapid healing occurs most often in younger people, because they have a stronger healing system. Anti-wound healing drugs, such as mitomycin-C and 5-FU help slow down the healing of the opening. If needed, glaucoma filtering surgery can be done a number of times in the same eye.
Is this an outpatient procedure or is an overnight stay in the hospital needed? Usually, filtering surgery is an outpatient procedure, requiring no overnight hospital stay. Within a few days after surgery, the eye doctor will need to check on the eye pressure. The doctor will also look for any signs of infection or increase in inflammation.
How long is the recovery time? For at least one week after surgery, patients are advised to keep water out of the eye. Most daily activities can be done, however, it is important to avoid driving, reading, bending, and doing any heavy lifting. Since each case is different, patients should check with their doctor for
specific advice.
How will the eye look after surgery? Is there a noticeable scar or redness? The eye will be red and irritated shortly after surgery, and there may be increased eye tearing or watering. The inner eye fluid flows through the surgically-created hole and forms a small blister-like bump called a bleb. The bleb, usually located on the upper surface of the eye, is covered by the eyelid, and is usually not visible.
Will vision be changed? Will glaucoma medications still need to be taken? There may be some vision changes, such as blurred vision, for about six weeks after the surgery. After that time, vision will usually return to the same level it was before surgery. Vision can sometimes improve after surgery in people who were previously using pilocarpine.
When pilocarpine drops are no longer taken, the pupil returns to normal size, allowing more light to enter the eye. In a few cases, the vision may be worse due to very low pressure. Cataracts or wrinkle in the macula area of the eye may develop. In terms of vision correction, a patient’s glasses or contact lenses may need to be changed after surgery.
Both gas permeable and soft contact lenses may be worn after glaucoma filtering surgery. There may be fitting problems due to the bleb. Special care is needed to avoid infection of the bleb. Contact lens users should discuss these problems with their eye doctor following surgery.
The Glaucoma Research Foundation acknowledges with appreciation Eve Higginbotham, MO, for her contributions to this information sheet. 490 Post Street, Suite 1427 • San Francisco, CA 94102 Telephone 415.986.3162 • Fax 415.986.3763 • www.glaucoma.org
