Fluid called aqueous humour is naturally produced within the eye and drains away through a complex sponge-like network called Trabecular meshwork. Glaucoma is the result of a build-up of this fluid caused by a blockage of the natural drainage channels of the eye. This pressure can damage the optic nerve which carries images from the eye to the brain, affecting your vision. If your current drops are not adequately maintaining your vision or you are unable to tolerate drops, a surgical option may be suitable for you.  

The surgeon cuts and folds back a small window of conjunctiva and then a smaller flap is made in the sclera, under which a small hole is formed into the front chamber of the eye.
The flexible iris would plug up this hole from the inside, so a V shaped segment of iris is removed just underneath the hole to keep it clear. And that’s it, a straightforward procedure. The flap is sewn in place with tiny releasable sutures that can be adjusted in the post-operative period to optimise intraocular pressure control. The fluid can escape through the hole into a space between the layers where it is reabsorbed and carried away from the eye, thereby reducing the pressure.

In broad terms, Glaucoma treatment can be separated into eye drops, lasers and surgery. Surgery is generally offered when the drops or laser you have been using have not lowered the eye pressure enough, you are getting side-effects, or you find it difficult to use the drops.

You may be suitable for a laser procedure, or you may need more eye drops. However, this may not control your Glaucoma and your vision may continue to get worse.

Now there are variations on a theme here, Nish Srikantha is a Moorfield’s trained Glaucoma surgeon who practices the “Moorfields Safer Surgery Technique” which helps produce improved surgical outcomes following Trabeculectomy.

Although any surgery is not guaranteed to be a lifelong solution, the Trabeculectomy has been around since the 1960’s. It has been through many modern advancements to increase its longevity such as the introduction of anti-scarring agents. The eye will naturally want to heal by scarring and this can unfortunately reverse the results of the Trabeculectomy. There are many techniques that the surgeon can use per-operatively, and after which will be discussed during consultation.

The location of the trabeculectomy is always under the upper eyelid. Once things have settled down, the signs of surgery are almost invisible as they are covered by the eyelid. In fact the only evidence of surgery is sometimes a small raised area, referred to as a ‘bleb’. Many patients don’t even notice they have one.