It is sometimes necessary to massage the eye or carry out a procedure called needling if it appears that the wound is healing too much. Needling is performed in the out-patient department after the instillation of local anaesthetic eye drops. It is considered as a safe and effective way of reopening the drainage tube. The procedure can be repeated if necessary. Patients have reported minimal discomfort only with this procedure. Patients who live a long distance from the hospital will likely be able to alternate post-operative appointments between their surgeon and a local ophthalmologist.
Activity after surgery. It is important to avoid strenuous activity during the early post-operative period including swimming, tennis, jogging and contact sports. It is permissible to watch television and read, as these will not harm the eye. For patients who wish to pray, it is better to kneel but not to bow the head down to the floor in the first two to three weeks.
Bending over can cause significant pain when the eye is still inflamed after surgery. Similarly, activities such as yoga that require head-down posturing should be avoided. As patients will be monitored closely following surgery, it is recommended that they consult their surgeon before commencing strenuous activity. If the eye pressure is very low after surgery the surgeon may suggest refraining from all exertion and remaining sedentary until the pressure is restored.
Typically someone working in an office environment would require two weeks off, if the post-operative course is smooth.
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Someone whose occupation involves heavy manual work or work in a dusty environment may require a month or more e. This can be discussed with your consultant. Contact lens use after trabeculectomy surgery. It is usually possible to restart contact lens use around four weeks and sometimes sooner after trabeculectomy surgery.
Not everyone can continue to wear contact lenses after trabeculectomy surgery, so this is something to consider before having a trabeculectomy operation. Whether or not contact lenses can be worn after surgery depends on the appearance and shape of the drainage bleb. The surgeon will usually be able to advise on this by six to eight weeks after surgery. Flying after surgery. Although it is safe to fly after surgery, patients should bear in mind that their surgeon will wish to see them for a number of post-operative visits to ensure that the eye pressure is at the correct level.
When is the eye back to normal? In most cases, it takes two to three months for the eye to feel completely normal and sometimes longer in more complicated cases. At this point a refraction spectacle test is usually required as the spectacle prescription may have changed slightly from the pre-surgery prescription. Success rates and complications. Long-term studies suggest that most people will achieve a low eye pressure without the need for additional glaucoma medication after trabeculectomy surgery.
In clinical trials, trabeculectomy has proven consistently more successful at lowering intraocular pressure than either medication or laser. The success rate of trabeculectomy at controlling the pressure varies according to a number of risk factors including the type of glaucoma, previous surgery, ethnicity, age and other conditions. In one study of trabeculectomy success, after 20 years almost 90 per cent were still successful. Just under two thirds of these required no glaucoma medication to control the pressure, whereas one third still required medication. Uncommonly, a patient will develop a pressure that is too low, requiring further surgery to elevate the pressure.
Severe complications are rare and may happen either if the eye pressure drops very low or very quickly during the early post-operative period, or if the eye becomes infected. Very low eye pressure is the biggest risk in the early post-operative period. Although it is often painless, it may be associated with a dull aching feeling or a throbbing sensation within the operated eye.
Patients who notice severe blurring of vision, distortion or a fluctuating curtain in their visual field should attend the eye casualty department as soon as possible for further assessment. Very low pressure or a precipitous drop in pressure can result in bleeding at the back of the eye choroidal haemorrhage. This is a very severe complication but rare. In order to ensure that this does not happen the surgeon will often suggest further intervention if the pressure becomes very low. Such intervention may consist of a return to the operating theatre to have the trap-door sutures tightened.
Sometimes the surgeon will inject a viscoelastic gel into the eye and wait to observe the result before deciding on further adjustment of the trap-door sutures, as the eye pressure will often stabilise by itself. Sometimes a simple adjustment of medication is sufficient, in which case, neither of the above will be required. In the author's experience, about five per cent of trabeculectomy patients require a return to the operating theatre in the first month after surgery for adjustment, either because the pressure is too high or too low.
The risk of serious infection or serious bleeding in the eye from trabeculectomy is rare approximately one in Longer-term risks. The longer-term risks of trabeculectomy are infection, discomfort, cataract and change in glasses prescription. Low pressure occasionally develops in the longer term, but generally the risk of low pressure is highest in the early post-operative period rather than later. While the risk of infection after surgery is rare, there is a very small on-going life-time risk that the drainage bleb might become infected.
If a patient who has had a trabeculectomy subsequently develops a red, sticky or painful eye, it is important they have their eye examined immediately by an ophthalmologist, as this may be a sign of an infection. While infection is rare, it may be very serious and can result in visual loss. The earlier any infection is treated, the better the outcome for the eye. The drainage bleb may become large. Occasionally this may extend below the eyelid or cause the eyelid to be raised or droopy. A large drainage bleb may cause interference with the tear film on the eye surface, and can create a feeling of discomfort or drying of the eye.
This occurs in about ten per cent of patients and is usually treatable with artificial tear drops. Occasionally, the discomfort is more severe and requires surgery to make the drainage bleb smaller. In patients who have not had cataract surgery, there is a risk that trabeculectomy may worsen an existing cataract. Raised eye pressure and glaucoma medications have been shown to cause cataract in population studies. In a study of patients, the likelihood of needing cataract surgery within 7.
Glaucoma: diagnosis and management
Astigmatism and other changes in glasses prescription. Most patients require a small change in their glasses prescription after trabeculectomy. Patients should refrain from changing their glasses until at least three months after the surgery and only once the eye pressure has stabilised. It is advisable to check with the doctor before changing glasses.
Rarely, a patient who does not require glasses before surgery develops a need for glasses after surgery. A Cochrane Systematic Review compared the effect of brimonidine and timolol in slowing the progression of open angle glaucoma in adult participants.
Participants in the brimonidine group had a higher occurrence of side effects caused by medication than participants in the timolol group. Studies in the s reported that the use of cannabis may lower intraocular pressure. These studies demonstrated some derivatives of marijuana lowered intraocular pressure when administered orally, intravenously, or by smoking, but not when topically applied to the eye. In , the American Academy of Ophthalmology released a position statement stating that cannabis was not more effective than prescription medications. In the American Glaucoma Society published a position paper discrediting the use of cannabis as a legitimate treatment for elevated intraocular pressure, for reasons including short duration of action and side effects that limit many activities of daily living.
From Wikipedia, the free encyclopedia. Glaucoma Acute angle closure glaucoma of the person's right eye shown at left. Note the mid-sized pupil , which was non- reactive to light , and redness of the white part of the eye. Specialty Ophthalmology Symptoms Vision loss , eye pain, mid-dilated pupil , redness of the eye, nausea   Usual onset Gradual, or sudden  Risk factors Increased pressure in the eye , family history, high blood pressure  Diagnostic method Dilated eye examination  Differential diagnosis Uveitis , trauma, keratitis , conjunctivitis  Treatment Medication, laser , surgery  Frequency 6—67 million   Glaucoma is a group of eye diseases which result in damage to the optic nerve and cause vision loss.
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Facts About Glaucoma | National Eye Institute
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Medical Management of Glaucoma in the 21st Century from a Canadian Perspective
Archived from the original on 11 October Copenhagen: EGS Congress. Archived PDF from the original on 17 October Find a Job Post a Job. Sooner or later, most people need cataract surgery. That includes glaucoma patients, but their disease complicates matters; these patients need extra care both before, during and after surgery. In addition, some positive side effects of cataract surgery usually seen in healthy eyes, such as a drop in intraocular pressure, may not always appear when a patient is being treated for glaucoma.
Although the evidence suggests that cataract surgery is likely to reduce IOP somewhat in a healthy eye, the evidence is far less clear for glaucoma patients. A few studies that have looked at this question have indeed found a reduction in the number of medications needed by glaucoma patients following cataract surgery. Most used a single IOP measurement before surgery to define the baseline, which subjects all subsequent analyses to regression to the mean, and postop measurements were not masked.
Furthermore, in most of these studies the use of medications was not controlled. That means the data is subject to significant potential bias. In order to look at the isolated influence of phaco, Steven L.
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Intraocular pressure was very carefully monitored in the Ocular Hypertension Treatment Study, making it a reliable source for data. Sixty-three patients in the medically untreated hypertensive group underwent cataract surgery during the study; this chart compares their IOPs to control subjects who did not undergo cataract surgery. Following cataract surgery IOPs dropped about 4 mmHg, and the effect persisted for several years. Adapted from Mansberger, et al. The IOPs of the untreated OHTS subjects hovered around 24 mmHg before surgery; the group that underwent phaco had a pressure drop of about 4 mmHg, which persisted for several years.
See chart, p. Also of note, the data from the OHTS study, as well as the others already mentioned, showed that the strongest predictor of a significant IOP drop after cataract surgery was a higher starting IOP. One study, for example, found that patients with starting IOPs in the upper 20s experienced a six-point drop in IOP, on average; patients with a starting IOP in the upper teens only showed a 2. Of course, most patients coming into cataract surgery with a known diagnosis of glaucoma are already on treatment, so using that data to guide clinical practice with a glaucoma patient is fraught with peril.
After we did phaco, I gave them a drug holiday before reintroducing their glaucoma medications to see how much pressure-lowering the phaco provided. My purely anecdotal experience was that their pressures did tend to drop a little; the majority of ocular hypertensive patients on treatment were able to stay off medications and still achieve the OHTS-specified percent IOP lowering for about a year. But after a year, most of them had to go back on medication to reach the OHTS-defined target.
This supports the conclusion that pressure-lowering after cataract surgery is not a long-term effect in glaucoma patients on medications. Again, this is anecdotal; there is no solid clinical data to confirm my experience. Assuming a pressure drop does occur in a glaucoma patient following cataract surgery, what kind of pressure drop should you expect?
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