Trabeculectomy and Tube Shunts are recommended for glaucoma patients when glaucoma is uncontrolled, despite medical treatment or in office laser therapy, and glaucoma is progressing. Typically also for patients at higher risk for vision loss from glaucoma.
What is Trabeculectomy?
Trabeculectomy is a shunting procedure in which a flap is made on the top part or white of the eye called the sclera and fluid is then allowed to egress from the eye lowering eye pressure. The lining of the eye called the conjunctivae is sewn over this flap. Typically sutures are placed to reduce flow in the initial postoperative period to avoid too low an eye pressure called hypotony.
Risks and Benefits of Trabeculectomy
Trabeculectomy comes with some very significant risks. Most importantly is that every patient can respond differently to surgery. One of the main risks is scarring which, if it happens, causes the operation to fail. For this reason, medications are given at the time of surgery called antimetabolites. These help prevent scarring. Other risks are wound leaking, swelling in the back of the eye, hemorrhage and infection. In general, Trabeculectomy has an 80 % success rate with a 5 % risk of vision-threatening loss of vision or blindness. Results vary from patient to patient. Other less vision-threatening risks such as discomfort, dry eye, and cataract progression are reported. There is also a chance for a return to the operating room as many complications can be fixed with a return to the operation room.
Dr. Lotufo uses general 2 shunts either an Amhed FP-7 or a Bearveldt. Amhed valves have lower risk of too low intraocular pressure, called hypotony, but Bearveldts may give a lower long-term pressure. The benefit of tube shunts is they can be done in eyes with previous scarring and work very well in eyes that have already had cataract surgery. Studies have suggested a lower risk of infection but also have reports of greater risk of corneal complications or extrusion, which can happen when the eye rejects the implant and scarring pushes part of the implant out of the eye. Many extrusions can be fixed with a second or sometimes even a third surgery. Postoperative care and recovery is the same for tube procedures as it is for trabeculectomy.