Mr El-Assal completed his Ophthalmology training in the North East of England. He accomplished his glaucoma sub-specialist fellowship in Moorfields Eye Hospital-London where he developed a special interest in minimally invasive glaucoma surgery (MIGS). He is currently working as a Consultant specialising in glaucoma and cataract surgery at Sunderland Eye Infirmary.
Trabeculectomy
Trabeculectomy surgery creates a new route for aqueous fluid to drain out of the eye, reducing the intraocular pressure.
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Summary
The raised intraocular pressure associated with glaucoma can damage the optic nerve, leading to loss of vision. Most glaucoma patients can control their pressures with eye drops or laser treatment. If drops and laser do not sufficiently lower the intraocular pressure then trabeculectomy surgery may be recommended. Trabeculectomy is a type of glaucoma surgery which creates a new route for the aqueous fluid to drain out of the eye, reducing the intraocular pressure. As the fluid drains a little conjunctival swelling, called a bleb, forms. The bleb is located at the top of the cornea, under the eyelid. Trabeculectomy surgery alone is usually sufficient to control the intraocular pressure, without the additional need for glaucoma drops.
The Process
Surgery takes 1 hour and is carried out under local anaesthetic, with sedation if required
The loose conjunctiva tissue is opened and a partial-thickness flap is created in the white sclera. The flap is secured with releasable sutures and the conjunctiva is closed. To reduce scarring a special chemical, called 5FU, is applied to the wound
Following surgery, as the eye starts to drain a little conjunctival bleb forms under the upper lid. The rate of drainage can be adjusted by releasing the flap sutures, if needed.
An antibiotic and an anti-inflammatory injection is given at the end of surgery.
Why MY Eye Clinic?
My Eye Clinic can provide expert consultant assessment of glaucoma.
My Eye Clinic has a full range of diagnostic equipment for glaucoma: corneal thickness measurement, intraocular pressure measurement, drainage angle assessment, automated visual field assessment and OCT scans of the optic disc.
My Eye Clinic has a new operating theatre fully equipped with the latest generation cataract machine (Alcon Centurion Gold), an excellent operating microscope and a new (Dorc Nexus) combined cataract and vitrectomy machine.
Your Consultants
Consultant Eye Surgeon with a specialist interest in Glaucoma
Mr Doherty undertook undergraduate and postgraduate medical training in Newcastle upon Tyne before proceeding to Ophthalmology specialist training in both the Northern and Yorkshire Deaneries. He subsequently completed an eighteen-month Glaucoma subspeciality fellowship at Moorfields Eye Hospital in London. He was appointed as a Consultant in Glaucoma and Cataract treatment at Sunderland Eye Infirmary in September 2013.
Costs
Trabeculectomy LA
£4100
Risks
Trabeculectomy is a well established surgical procedure with a success rate of 95% in controlling the intraocular pressure. Risks associated with the procedure include:
Failure of the surgery to control the eye pressure (5%). This generally occurs as a result of scarring around the eye. This can often be revised by breaking up the scar tissue.
Overdrainage that can cause very low eye pressure (5%). This can be temporary or it can require additional surgery to revise the trabeculectomy.
Overall, revision surgery is required in under 5%.
Trabeculectomy is known to speed up the natural development of cataracts. Up to 50% of patients, who have not yet had cataract surgery, will develop lens opacities in 2-4 years.
Rare risks: Infection (<1%), uncontrolled inflammation (<1%), permanent irreversible reduction of vision (<1%).
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