Trabeculectomy
Harley Street, London
Trabeculectomy remains the gold standard surgical treatment for glaucoma when significant intraocular pressure reduction is required to preserve vision. This time-tested procedure creates a new drainage pathway for aqueous humour, bypassing the eye’s compromised natural drainage system to achieve substantial and sustained pressure reductions. Miss Shreya Haldar’s expertise in modern trabeculectomy techniques ensures optimal outcomes whilst minimising complications through meticulous surgical technique and comprehensive post-operative care.
For patients with advanced glaucoma or those who require aggressive pressure reduction to prevent further vision loss, trabeculectomy offers the most reliable method of achieving the low intraocular pressures necessary to preserve remaining sight. The procedure’s proven track record spans decades, with continuous refinements improving success rates and reducing complications.
Understanding Trabeculectomy
Trabeculectomy is a filtering surgery that creates a new drainage channel for aqueous humour to flow from inside the eye to a space beneath the conjunctiva, where it can be absorbed by surrounding tissues. This artificial drainage pathway bypasses the eye’s natural drainage system when it becomes too damaged or inefficient to control intraocular pressure adequately.
The procedure involves creating a partial-thickness flap in the sclera (the white part of the eye) and removing a small piece of tissue to create an opening into the eye’s anterior chamber. Aqueous humour flows through this opening into a filtering bleb beneath the conjunctiva, where it’s gradually absorbed.
The success of trabeculectomy depends on achieving the right balance of drainage. Too little drainage fails to adequately reduce pressure, whilst excessive drainage can cause complications such as hypotony or infection. Modern techniques and post-operative management strategies have significantly improved this balance.
When Trabeculectomy Is Necessary
Trabeculectomy is typically recommended when less invasive treatments have failed to achieve adequate pressure control or when aggressive pressure reduction is needed to prevent further vision loss in advanced glaucoma.
Indications for Surgery
The primary indication for trabeculectomy is inadequate intraocular pressure control despite maximum tolerated medical therapy. This situation often occurs in advanced glaucoma where target pressures must be very low to prevent further optic nerve damage.
Patients who cannot tolerate glaucoma medications due to side effects or allergic reactions may require trabeculectomy to achieve necessary pressure control. Similarly, those unable to comply with complex medication regimens benefit from surgical intervention.
Progressive glaucomatous damage despite treatment indicates the need for more aggressive pressure reduction. Trabeculectomy can achieve the low pressures necessary to halt disease progression.
Patient Selection Criteria
Ideal candidates for trabeculectomy are those with significant glaucomatous damage who require substantial pressure reductions that cannot be achieved with medications or laser treatments alone.
Age considerations are important, as younger patients may require repeat procedures over their lifetime. The tissue-sparing nature of modern techniques helps preserve options for future surgeries if needed.
General health factors that affect healing and the ability to comply with post-operative care requirements are carefully evaluated during the pre-operative assessment.
The Trabeculectomy Procedure
Trabeculectomy is performed as an outpatient procedure under local anaesthesia with sedation for patient comfort. The surgery typically takes 45-60 minutes, depending on the complexity of the individual case.
Pre-Operative Preparation
Comprehensive pre-operative evaluation ensures that patients are appropriate candidates for surgery and helps optimise outcomes. This includes assessment of conjunctival health, previous treatments, and general health factors that might influence healing.
Medications that might affect healing or bleeding are adjusted as necessary. Patients receive detailed instructions about pre-operative preparation and what to expect during and after surgery.
Surgical Steps
The procedure begins with careful preparation of the surgical site and administration of local anaesthesia. A corneal traction suture provides proper eye positioning throughout the surgery.
Miss Haldar creates a conjunctival flap to access the sclera, then fashions a partial-thickness scleral flap that will control aqueous flow. A small piece of tissue is precisely removed to create the drainage opening.
If indicated, antimetabolite application helps prevent excessive scarring. The scleral flap is then sutured in position to allow controlled drainage, followed by careful conjunctival closure.
Immediate Post-Operative Care
Following surgery, a protective shield covers the eye and antibiotic and anti-inflammatory medications are prescribed. Patients receive detailed instructions about post-operative care and activity restrictions.
Close monitoring during the first few weeks ensures proper healing and optimal pressure control. Regular follow-up appointments allow for any necessary adjustments to promote success.
Success Rates and Outcomes
Modern trabeculectomy offers excellent success rates when performed by experienced surgeons using contemporary techniques. Success is typically defined as achieving target intraocular pressures without sight-threatening complications.
Pressure Control Success
Studies demonstrate that trabeculectomy achieves adequate pressure control in 80-90% of patients at five years post-operatively. The procedure can reduce intraocular pressure by 30-50% or more from pre-operative levels.
This significant pressure reduction is often sufficient to halt glaucoma progression even in advanced cases. The ability to achieve very low pressures makes trabeculectomy invaluable for preserving vision in severe glaucoma.
Visual Outcomes
Most patients maintain or improve their visual function following successful trabeculectomy. The preservation of remaining vision is the primary goal, though some patients experience slight improvements due to better pressure control.
Quality of life improvements are significant for many patients who achieve freedom from multiple daily medications and the anxiety associated with progressive vision loss.
Long-Term Durability
Trabeculectomy provides durable pressure control for many years in most patients. Some individuals may require additional procedures over time, but the initial surgery often provides decades of effective pressure control.
Factors that influence long-term success include patient age, glaucoma severity, healing characteristics, and adherence to post-operative care requirements.
Why Choose Miss Shreya Haldar for Trabeculectomy?
Miss Haldar’s expertise as a consultant ophthalmic surgeon encompasses extensive experience with trabeculectomy surgery using the most current techniques. Her meticulous surgical approach optimises outcomes whilst minimising complications.
Her comprehensive pre-operative evaluation ensures that patients are appropriate candidates for surgery and that expectations are realistic. This careful patient selection contributes to high success rates and patient satisfaction.
Located on Harley Street in London, Miss Haldar’s practice provides access to state-of-the-art surgical facilities and the latest surgical technologies. Her collaboration with leading institutions ensures that patients benefit from the most current advances in trabeculectomy techniques.
Miss Haldar’s commitment to post-operative care ensures optimal healing and long-term success. Her availability for urgent concerns and comprehensive follow-up programme provide patients with confidence and support throughout their recovery.
The practice’s dedication to patient education helps you understand the procedure and its role in preserving your vision. This knowledge enables informed decision-making and realistic expectations about surgical outcomes.
When advanced glaucoma threatens your remaining vision, expert trabeculectomy surgery can preserve your sight. Miss Shreya Haldar’s mastery of modern trabeculectomy techniques provides the pressure control necessary to halt glaucoma progression.
Contact our Harley Street practice today to discuss how this proven surgery can protect your precious eyesight. When your vision is at stake, you need the gold standard treatment delivered by London’s leading glaucoma surgeon.