Combined Surgery

Trabeculectomy and Cataract Surgery

When are glaucoma and cataract surgery performed together?

Combined cataract and glaucoma (trabulectomy) surgery may be indicated and recommended in select patients. Combined cataract and glaucoma surgery is usually performed in patients who have glaucoma that is not adequately controlled with glaucoma medications and who also have visual loss due to a cataract. Your doctor will discuss with you whether you are a potential candidate for simultaneous cataract and glaucoma surgery.

What are the risks or complications from combined glaucoma surgery and cataract surgery?

Although most patients undergoing combined glaucoma surgery will benefit from improvement in eye pressure and improved vision in the operated eye, as with all surgical procedures there are potential risks in addition to benefits. Most problems following surgery can be successfully treated or may even resolve spontaneously. However, occasionally, additional surgery may be necessary for persistent post-operative problems or new problems that may develop later. Complications occurring during or following combined trabeculectomy and cataract surgery include but are not limited to; early infection (days to weeks after surgery), late infection (months to years after trabeculectomy surgery), choroidal hemorrhage (sudden bleeding behind the retina), retinal tear or detachment, choroidal effusion (fluid accumulation behind the retina), macular edema (swelling of the central part of the retina), dislocation of all or part of the cataract, excessively low eye pressure, chronic leakage of internal eye fluid, swelling of the cornea, lens dislocation, dry eye syndrome, chronic discomfort, chronic glare, and droopy lid. Mild visual loss that is not reversible occurs on the average in about 1-5% of patients and severe visual loss including total and irreversible visual loss usually occurs in less than 1% of operated eyes.

On the day of surgery you will be given sedation by the anesthesiologist to relax you and your doctor will administer local anesthesia to numb the eye for surgery. The procedure usually lasts about 1 hour, longer in complicated eyes.

Pre-operative Instructions

  1. Glaucoma medications need to be instilled in the eye up to the morning of glaucoma surgery. Patients who are taking glaucoma pills (diamox/acetazolamide or neptazane/methazolamide), unless instructed otherwise should take the morning dose with a small sip of water.
  2. Unless instructed otherwise, discontinue xalatan, travatan, travatan Z, or lumigan 5 days before surgery in the operative eye only.
  3. Beginning 5 days before surgery start Pred forte, Econopred plus, or prednisolone acetate in operative eye one drop 4 times a day.
  4. Beginning 3 days before cataract surgery start Zymar in operative eye one drop 4 times a day.
  5. Scrub lashes with baby shampoo mixed with water (1 part shampoo 3 parts water) using a cotton swab and then rinse with warm water beginning 5 days prior to surgery. Alternatively, an over the counter eyewash such may be used instead of baby shampoo. Your doctor may suggest different eyewash brands.
  6. You may need antibiotics pills, drops, or ointment before surgery. You doctor will advise you if these are necessary.
  7. Food and drink are permitted only until midnight the day before surgery. Afterwards you must not eat or drink anything except for your heart and blood pressure medications. They should be taken the morning of surgery with a small sip of water. If you are taking blood thinners such as aspirin, plavix, or coumadin only your family physician or cardiologist can tell you if it is safe to stop them prior to surgery. Your family physician will instruct you regarding the use of your non-eye medications prior to surgery.

Post-Operative Instructions and Expectations

Expect to be seen the first day after surgery and then weekly for the first month. Close follow-up is extremely important in order to monitor for problems, observe and control the healing response, and therefore, maximize the likelihood of surgical success.

A separate handout with detailed post-operative instructions will be given to you at the time of surgery.