TRABECULATOMIA

Certainly the most common operation is TRABECULATOMIA. This surgical method is perhaps the most ancient ocular operation still in use. It consists of "carving" a small door inside the eye external shell (sclera) thus allowing an indirect connection between the eye internal part (fore room) and the eye external part through the sub-conjunctive space.

The gear thus created can be compared to the "valve of a pressure pot": when the internal pressure increases, the valve lets outflow one part of the aqueous humor thus reducing the eyeball internal pressure.

The Complications

During a glaucoma operation, the most frequently occurring complications are the following:

The less frequent event is the infection related to the continuous connection between the eye internal part and the conjunctive, which is normally occupied by several bacteria as it is directly in contact with the ocular external surface; the second less frequent event is the blood pouring inside the eye related to a possible wound produced on a small vessel during the eyeball carving phase. Whatever method is adopted, the most common trouble related to the glaucoma surgery is that the filtering action that we try to produce after some time can be hindered by the normal healing phenomena (third complication). In order to fight against this normal process, particular substances are utilized for inhibiting the healing tissue proliferation (ANTIMETHABOLITES) or sometimes we try to increase the connection making up a "wider" valve. Through this way during the first days an excessive filtering action is produced, which can be the cause of the fourth complication, that is the excessively low ocular pressure (OCULAR HYPOTONE), that in any case is only temporary and easily treatable. Finally it is also very important to remember that sometimes the surgical operations performed for this kind of intervention can produce a rapid dulling of crystalline because of traumatic effects on it (last complication). However, we have to remember that:

VISCOCANALTOMIA AND DEEP SCLEROTOMY

The surgical proceeding that is nowadays more and more developed is the filtering surgery without direct opening of eyeball and therefore a surgery that reduces considerably, when it does not remove, these complications. In fact this new operation is based on the connection of the fore room with the aqueous humor normal outlets, exploiting an action which can be compared to the blotting paper when in contact with some liquid. This action concerning the ocular field is called "percolation".
This operation can be performed by two different methods: the VISCOCANALTOMIA and the DEEP SCLEROTOMY .The first method helps the aqueous humor outlet through the natural collecting vessels, mechanically “enlarging” them, thus increasing the flow. The second method consists of helping the same action but through the construction of a space that can be compared to a tiny "tank", where the aqueous humor is collected before out-flowing outside the eyeball.

OTHER OPERATIONS

For particular cases an operation can be recommended for installing a small plastic "valve".These draining plants have the same function of the above mentioned operations but the aqueous humor outlet way through the sub-conjunctive space occurs through a system of plastic manifolds instead of a way built up by the surgeon. Generally these plants have not a long lifetime because of the frequent and early obstruction of the valves vessels, and therefore these methods are adopted by surgeons only for particular cases such as neo-vascular glaucoma, when the conventional surgery is useless for most of times.

How Does the Treatment Occur?

All the above mentioned operations are performed in the day-hospital under local anhestesia (anhestetic peri-eyeball dropping) or even topical (drops only) at our surgical institute C.C.FATA MORGANA and our choice is mainly referred to the DEEP SCLEROTOMY, when possible, through installation of collagen material that increases the filtering action lifetime. The patient is hospitalized for about 2 hours, time needed for the eye preparation (collyrium dropping), the performance of the usual analyses (ECG, visit for anhestesia, etc.), the filling up of the hospitalization record, the operation and the final discharging when the therapy and behavior to be followed at home are explained. Besides that we must remember that the above described glaucoma surgical operations can also be associated to the crystalline PHACOEMULSIFICATION operation (removal of cataract).

Cautions to be considered After the Glaucoma Surgical Operation

For most of cases, the patient is discharged one or more hours after operation, but the eye needs one-two months for a complete rehabilitation and according to the kind of operation; some caution and care are then needed. The eye is usually bandaged for one or two days, then bandages are removed and dark goggles are needed. During the days following the operation the eye looks more or less red and slightly painful; there is also the sensation of a foreign body (due to the stitches and to the cut) and some intolerance to the light; all these symptoms are normal and the patient should not be worried.
During the days after operation, the operated eyesight is not clean; some days or tenth of days are needed for reaching the best levels.
When the operated patient goes home, he shall start since the day of discharge to utilize the prescribed collyrium; generally before leaving the Institute he is provided with a prescription that indicates the drugs to be utilized.
When there is more than one prescribed collyrium, they have to be dropped with an interval of a few minutes one after the other. One or more times a day the operated eye eyelids can be gently cleaned by a sterile gauze dressing or by properly prescribed handkerchiefs; but the person who performs this action must avoid any pressure on the eyeball and in any case on the operated portion; the patient can also wash his face, but without rubbing or pushing on the operated eye.
During the days after operation, the bandage is replaced with the dark goggles that we supply; their purpose is to protect eye against light, air, dust and above all against possible shocks. For this reason, during the night it is good practice to protect the operated eye with the adequate plastic shell supplied, at least for the first weeks; the shell must be kept on place by plasters; it is useful for avoiding unexpected shocks and protecting against possible accidental rubbing during the sleeping time.

PREVENTION

Even if treatments effectively reduce the ocular pressure, nowadays there is no final treatment for glaucoma and therefore it is not possible to recover the visual function when the disease already compromises it. Therapy can avoid further damages and particularly when practiced during the disease early phases.