trabeculectomy


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Trabeculectomy

 

Definition

Trabeculectomy is a surgical procedure that removes part of the trabeculum in the eye to relieve pressure caused by glaucoma.

Purpose

Glaucoma is a disease that injures the optic nerve, causing progressive loss of vision. Presently, glaucoma is a major cause of blindness in the United States If caught early, glaucoma-related blindness is easily prevented. However, since it does not produce symptoms until late in its cycle, periodic tests for the disease are necessary.
Glaucoma is usually associated with an increase in the pressure inside the eye. This increase occurs in front of the iris in a fluid called the aqueous humor. Aqueous humor is supposed to exit through tiny channels between the iris and the cornea, in an area called the trabeculum. When the trabeculum is blocked, pressure from the build up of aqueous humor either increases rapidly with considerable pain and redness, or, as in most cases, the pressure builds slowly with no symptoms until much of the vision is lost. Trabeculectomy is the last treatment employed for either type of glaucoma. It is used only after medications and laser trabeculoplasty (less invasive procedure that uses a laser to open the blocked trabeculum) have failed to alleviate the pressure.

Description

A trabeculectomy involves removing a tiny piece of the eyeball right at the place where the cornea connects to the sclera (the white part), and creating a flap to allow fluid to escape the anterior chamber without deflating the eye. Along with that tiny piece of cornea and sclera comes a piece of the iris. The whole area is called the trabeculum. Fluid can then flow out onto the surface of the eye and be absorbed by the conjunctiva, the transparent membrane that lines the sclera and the eyelids. Sometimes, an additional piece is taken out of the iris so that anterior chamber fluid can also flow backward into the vitreous part of the eye. This procedure is called an iridectomy.

Preparation

The procedure and its benefits and possible complications are fully explained. Antiglaucoma drugs are prescribed before surgery. Added pressure on the eye caused from coughing or sneezing should be avoided.

Aftercare

Eye drops, and perhaps patching, will be needed until the eye is healed. The pressure inside the eye will still be monitored. Immediately following the procedure, the patient may experience blurred vision.

Risks

Infection and bleeding are risks of any surgery. Scarring can cause the drainage to stop. A third of patients with trabeculectomies will develop cataracts.

Resources

Books

Vaughan, Daniel, editor. General Ophthalmology. 13th ed. Stamford: Appleton & Lange, 1993.

Key terms

Cornea — Transparent film that covers the iris and pupil.
Iris — Colored part of the eye, which is suspended in aqueous humor and perforated by the pupil.
Sclera — White, outer coating of the eyeball.
Trabeculoplasty — Laser surgery that creates perforations in the trabeculum, to drain built up aqueous humor and relieve pressure.
Trabeculum — Tissue that is a drainage point for aqueous humor in the eye.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.

trabeculectomy

 [trah-bek″u-lek´tah-me]
creation of a fistula between the anterior chamber of the eye and the subconjunctival space by surgical removal of a portion of the trabecular meshwork, performed to facilitate drainage of the aqueous humor in glaucoma.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.

tra·bec·u·lec·to·my

(tră-bek'yū-lek'tŏ-mē),
A filtering operation for glaucoma by creation of a fistula between the anterior chamber of the eye and the subconjunctival space, through a subscleral excision of a portion of the trabecular meshwork.
[trabecula + G. ektomē, excision]
Farlex Partner Medical Dictionary © Farlex 2012

tra·bec·u·lec·to·my

(tră-bek'yū-lek'tŏ-mē)
A filtering operation for glaucoma by creation of a fistula between the anterior chamber of the eye and the subconjunctival space.
[trabecula + G. ektomē, excision]
Medical Dictionary for the Health Professions and Nursing © Farlex 2012

trabeculectomy

An eye operation to treat cases of GLAUCOMA that cannot be controlled by medication. Trabeculectomy provides a new outlet route for the aqueous humour which is under excessive pressure.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005

trabeculectomy 

A type of filtration surgery aimed at lowering the intraocular pressure by excising a small portion of the sclera and peripheral iris to create a passage allowing aqueous humour to flow from the anterior chamber out of the eye into the subconjunctival space. The hole is protected by a scleral flap, which is sutured back at the end of the procedure to reduce the risk of overfiltration and hypotony. See cyclodialysis.
Millodot: Dictionary of Optometry and Visual Science, 7th edition. © 2009 Butterworth-Heinemann
References in periodicals archive ?
Eight patients in the TA group required a bleb revision ( n = 5) or a secondary glaucoma surgery ( n = 3; two trabeculectomy and one transscleral cyclophotocoagulation).
Khanna, M.D., from the Mayo Clinic in Rochester, Minn., and colleagues conducted a prospective cohort study involving 160 consecutive, prospectively enrolled medically or surgically treated adult patients with glaucoma; 36 had undergone glaucoma drainage device surgery, 51 underwent trabeculectomy, and 73 were medically treated.
Though trabeculectomy has stood the test of time with its inherent advantages over many other surgical procedures, deep sclerectomy still holds an equal place in management.
The introduction of the Moorfields Safer Surgery System has improved the surgical outcomes and safety profile of trabeculectomy [1, 2].
He had previously undergone a trabeculectomy on his left eye but developed bullous keratopathy 3 years after the surgery.
It may affect the outcome of surgical procedures that require healthy conjunctiva such as trabeculectomy if needed in the future for those patients [18].
I have whiled away many hours dabbling in procedures outside my field and enjoyably learned so much of what it is that my professional colleagues do; how else would a general surgeon really understand what goes on during a trabeculectomy or how to replace a knee?
They discuss trabeculectomy, deep sclerectomy, glaucoma drainage device surgery, postoperative management of filtering procedures, the role of the ocular surface, and modulation of scarring processes in glaucoma surgery; new devices and techniques, including laser-assisted techniques, viscocanalostomy and canaloplasty, and ab interno Schlemm's canal surgery; and surgical approaches to angle-closure glaucoma, concomitant cataract and glaucoma, pediatric glaucoma, and refractory glaucoma.
"Surgeries for glaucoma include trabeculectomy, in which a surgeon makes a flap/pocket to allow fluid to drain out, and implantation of a valve device into which fluid drains.
A successful trabeculectomy is characterized by an elevation of the conjunctiva at the surgical site, commonly referred to as a filtering bleb [3].