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Trabeculectomy

Filtering glaucoma surgery creating a guarded scleral fistula with conjunctival bleb to lower intraocular pressure by enabling aqueous humor outflow from anterior chamber to subconjunctival space.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Göz Hastalıkları department. Book Appointment →

What is Trabeculectomy?

Trabeculectomy is a guarded filtration surgery developed by Cairns in 1968 that creates a controlled fistula between the anterior chamber and subconjunctival space, lowering intraocular pressure (IOP) by enabling aqueous humor egress around a scleral flap.

The procedure involves a 50% partial-thickness scleral flap, removal of corneoscleral block (sclerotomy), peripheral iridectomy, and conjunctival closure forming a filtering bleb. Mitomycin C 0.2-0.4 mg/mL or 5-FU is applied for 1-3 minutes to inhibit fibroblast proliferation.

Indications include primary open-angle glaucoma, normal-tension glaucoma, pseudoexfoliative glaucoma, pigmentary glaucoma, and uveitic glaucoma uncontrolled despite maximum medical therapy or laser. Modern variants include Ex-PRESS shunt and trabeculectomy with releasable sutures.

Symptoms

Progressive visual field loss despite maximum medications
Optic nerve cupping progression on OCT
Elevated IOP >21 mmHg on multiple medications
Glaucomatous optic neuropathy with vision threat
Patient intolerance to medications
Poor medication compliance
Need for cataract surgery in advanced glaucoma

Risk Factors

Primary open-angle glaucoma (most common indication)
Normal-tension glaucoma with progression
Pseudoexfoliative glaucoma with rapid progression
Uveitic glaucoma with steroid response
Failed previous laser trabeculoplasty
Young age and dark iris (higher scarring risk)
Conjunctival scarring from previous surgery
Active uveitis or neovascular glaucoma

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • IOP not controlled with maximum tolerated medical therapy
  • Progressive visual field loss despite treatment
  • Optic nerve damage progression on OCT
  • Inability to tolerate or comply with eye drops
  • Advanced glaucoma at diagnosis requiring rapid IOP control
  • Pre-cataract surgery planning in advanced glaucoma
  • Failed previous selective laser trabeculoplasty

Treatment Methods

01
Pre-operative biometry, gonioscopy, optic nerve OCT, visual field testing
02
Peribulbar or sub-Tenon anesthesia
03
Fornix-based or limbus-based conjunctival flap creation
04
Mitomycin C 0.2-0.4 mg/mL applied to subconjunctival space for 1-3 minutes, copious irrigation
05
Half-thickness scleral flap (3x4 mm trapezoidal or rectangular)
06
Anterior chamber entry and corneoscleral punch (Kelly Descemet punch) for sclerotomy
07
Peripheral iridectomy preventing iris incarceration
08
Scleral flap closure with adjustable or releasable 10-0 nylon sutures
09
Conjunctival closure with 10-0 nylon or vicryl with running sutures
10
Postoperative topical antibiotics, corticosteroids, atropine, and IOP monitoring with bleb evaluation
11
Suture lysis or release at 2-6 weeks based on IOP and bleb function

Which Department to Visit?

You can visit our Göz Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.