Trabectome surgery to treat glaucoma

Glaucoma is a disease causing the deterioration of the optic nerve, which is essential for clear vision. If not treated, it can lead to the loss of vision. Esteemed consultant ophthalmic surgeon and glaucoma specialist Mr Atul Bansal, who treats patients in Coventry and Birmingham, discusses the benefit of treating glaucoma with trabectome surgery and also discusses some potential complications that can arise from the procedure. 

What is trabectome surgery?

Trabectome surgery is a minimally invasive glaucoma surgery to control pressure in patients with primary open-angle glaucoma and monocular hypertension. While it is a relatively new technique, it's very well-established and researched. It is approved by the National Institute of Clinical Excellence, and we've been using it for many years successfully in a number of patients.

It works by removing the resistance of the flow of fluid from the eye into the natural channels of the eye and it spares cutting off a significant amount of tissue, which is required in other major glaucoma surgery. In summary, it helps by re-establishing the natural pathways for fluid to flow and helps control the pressure without adversely affecting the tissues and minimising complications.

How does trabectome surgery compare to other types of glaucoma surgery?

These days, there is a big spectrum of glaucoma surgery, ranging from laser to major glaucoma surgery like tube insertion. Trabectome is very effective. It helps to reduce the pressure by about twenty-five percent in the majority of patients with moderate glaucoma or patients who need to reduce their pressure to between fifteen and twenty. It is really useful because it reduces the number of complications, the length of the surgery, and follow-ups.

If a patient needs to reduce the pressure in the eye to about ten, then we would recommend something else like trabeculectomy, an incisional glaucoma surgery.  However, a large number of patients who undergo glaucoma surgery, can undergo trabectome surgery to reduce their pressure and prevent the need for bigger surgery.

 Who is a suitable candidate for trabectome surgery?

Trabectome surgery can work for a variety of patients. It can be used to treat young patients, including children, to elderly patients. It works best in open-angle glaucoma cases and patients who need a moderate reduction of pressure are the ideal candidates.

A benefit of trabectome surgery is, that it can be combined with cataract surgery as well, so if someone is undergoing surgery to treat cataracts, they can combine it with trabectome surgery, increasing the time by only ten minutes. The chance of complications doesn’t increase significantly either. 

What is the success rate of trabectome surgery?

Usually, recovery from the procedure is very quick. Like any surgery though, trabectome surgery has its pros and cons. It works very well to reduce the pressure by twenty to twenty-five percent in eighty-five to ninety percent of patients. Unfortunately, there is no glaucoma surgery that has a hundred percent success rate.   

What are the potential side effects to be aware of?

As mentioned, this is a minimally invasive glaucoma surgery so its side effects are limited and minimal, when compared to some other major glaucoma surgeries. However, we always explain all potential side effects to the patients, ranging from mild to severe.

Sometimes the patient may experience a tiny amount of bleeding in the eye, from the opening of the natural draining channels, which can cause blurred vision for a few days. This is very uncommon because of the modifications made to the surgery to minimise the risk of bleeding. Patients who are on blood thinning agents may be recommended an alternative surgery.

One in a thousand patients can experience a significant reduction in vision, as a result of an infection or bleeding. In very rare cases, patients can lose vision as well. We take all the precautions necessary for each surgery but we are realistic and we expect our patients to be aware of the potential problems.

Mr Atul Bansal is a leading consultant ophthalmic surgeon based in Coventry and Birmingham who specialises in the treatment of glaucoma. If you would like to book a consultation with him, you can do so by visiting his Top Doctors profile.