Trabeculectomy

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Things you need to know

What is Trabeculectomy?

Trabeculectomy is a surgical procedure to treat glaucoma by creating a new drainage pathway for aqueous humor, lowering intraocular pressure (IOP) to prevent optic nerve damage and vision loss. It’s typically performed when medications or laser treatments fail to control glaucoma. In India, trabeculectomy is conducted in ophthalmology departments at hospitals like Apollo, Fortis, Medanta, and AIIMS, often at affordable costs. Since we’ve discussed related procedures like glaucoma valve implants and retinal detachment surgery, this overview complements that context. Understanding the procedure, costs, recovery, risks, and frequently asked questions (FAQs) is essential for patients in India to make informed decisions.

Why do you need Trabeculectomy?

Trabeculectomy is indicated for:

Uncontrolled glaucoma:
- Primary open-angle glaucoma (POAG): High IOP despite maximum medical therapy or laser trabeculoplasty.
- Angle-closure glaucoma: After iridotomy fails to control IOP.
- Secondary glaucoma: E.g., uveitic, traumatic, or neovascular glaucoma.
Progressive optic nerve damage:
- Worsening visual field loss or optic disc cupping despite treatment.
High-risk cases:
- Young patients, high baseline IOP (>30 mmHg), or advanced glaucoma needing rapid IOP reduction.

The procedure aims to lower IOP by creating a filtering bleb (a small reservoir under the conjunctiva) to drain aqueous humor, typically achieving an IOP of 10–15 mmHg to halt glaucoma progression.

Why Do Trabeculectomy Costs Vary in India?

Costs range from ₹30,000 to ₹1 lakh per eye:

Procedure Complexity: Standard trabeculectomy (₹30,000–₹50,000); with MMC/5-FU or revisions (₹50,000–₹1 lakh).
Hospital/Location: Higher in metro cities (Apollo, Fortis); lower in government hospitals (AIIMS, ₹10,000–₹25,000; often subsidized under schemes like Ayushman Bharat).
Surgeon’s Expertise: Experienced glaucoma specialists charge more.
Additional Costs: Anesthesia (₹5,000–₹10,000), hospital stay (₹5,000–₹10,000/day), pre-op tests (₹2,000–₹5,000), medications (₹1,000–₹3,000).
Insurance: Covered for medical necessity; confirm with your provider.

Trabeculectomy Procedure

Before Surgery Evaluation:
- Diagnosis:
  - Tonometry: Measures IOP (normal: 10–21 mmHg; glaucoma: often >21 mmHg).
  - Gonioscopy: Assesses the drainage angle.
  - Optic disc exam: Evaluates optic nerve damage (e.g., cupping).
  - Visual field test: Detects peripheral vision loss.
  - Pachymetry: Measures corneal thickness (affects IOP readings).
  - Blood tests: Blood sugar, clotting profile.
- Medications: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; continue glaucoma drops until surgery.
- Consent: Risks, including infection, are explained.
Surgical Techniques:
- Trabeculectomy:
  - Performed under local anesthesia (peribulbar or sub-Tenon’s block), lasting 45–60 minutes.
  - A conjunctival flap is created (fornix-based or limbus-based) to access the sclera.
  - A partial-thickness scleral flap is made near the limbus (cornea-sclera junction).
  - A small piece of tissue (trabecular meshwork) is removed to create a drainage channel into the subconjunctival space.
  - Mitomycin-C (MMC, 0.02–0.04%) or 5-Fluorouracil (5-FU) may be applied for 1–5 minutes to reduce scarring (esp. in high-risk cases).
  - The scleral flap is loosely sutured (adjustable or releasable sutures) to control outflow.
  - The conjunctiva is closed with fine sutures (e.g., 8-0 Vicryl), forming a filtering bleb.
- Intraoperative Tools:
  - Operating microscope: Enhances precision.
  - Mitomycin-C/5-FU: Reduces scarring.
  - Adjustable sutures: Fine-tune drainage post-op.
After Surgery:
- Observation: 1–2 days in hospital.
- Eye care: Antibiotic/steroid drops (e.g., prednisolone, moxifloxacin) for 6–8 weeks; stop prior glaucoma drops in the operated eye.
- Pain management: Mild discomfort for 2–5 days; managed with acetaminophen.
- Instructions: Avoid rubbing the eye, heavy lifting, or water exposure for 4–6 weeks; wear an eye shield at night.

Recovery After Trabeculectomy

Hospital Stay: 1–2 days.
Post-Surgery Care:
- Vision: May be blurry for 1–2 weeks due to swelling or IOP changes; stabilizes in 4–6 weeks.
- IOP: Reduced within days; target 10–15 mmHg; monitored closely.
- Eye care: Antibiotic/steroid drops for 6–8 weeks; avoid water, dust, or rubbing the eye for 4 weeks.
- Activity: Avoid heavy lifting, bending, or strenuous activity for 4–6 weeks; normal activities (e.g., reading) in 1–2 weeks.
- Bleb care: The bleb should remain flat; a raised or leaking bleb may need intervention.
- Discomfort: Mild irritation or foreign body sensation for 1–2 weeks; managed with drops.
Follow-Up:
- Visits at 1 day, 1 week, 1 month, then every 3 months for 1 year to monitor IOP and bleb function.
- Suture release (if adjustable): 1–4 weeks post-op to enhance drainage if needed.

Most resume normal activities in 2–4 weeks; full recovery takes 4–6 weeks. Success rate: 70–90% achieve IOP control at 1 year (may need drops); vision preservation depends on pre-existing optic nerve damage.

Risks and Complications

Surgical Risks:
- Bleeding (1–3%): Hyphema (blood in anterior chamber); usually resolves spontaneously.
- Infection (1–2%): Bleb-related infection (blebitis) or endophthalmitis; treated with antibiotics, may need surgery.
- Leaking bleb (5–10%): Excessive drainage causing low IOP (hypotony); may need suturing.
Post-Surgery:
- Hypotony (5–10%): Too-low IOP (<5 mmHg) causing blurry vision or choroidal detachment; may resolve or need intervention.
- Bleb failure (10–20%): Scar tissue blocks drainage; may need needling, 5-FU injections, or revision surgery.
- Cataract (20–30% within 2–5 years): Accelerated by surgery; may need cataract surgery.
- Vision loss (1–3%): Rare; due to hypotony, infection, or uncontrolled IOP.
Long-Term:
- Bleb leak (1–5%): Late-onset; increases infection risk; may need repair.
- Encapsulated bleb (5–10%): Thickened bleb wall; may need needling or revision.

Report sudden vision loss, severe pain, redness, or discharge promptly.

Frequently Asked Questions (FAQs)

What causes the need for trabeculectomy?

Uncontrolled glaucoma (e.g., POAG, angle-closure, secondary) with progressive optic nerve damage or high IOP despite treatment.

Can I avoid trabeculectomy?

Yes, if earlier treatments work: Medications, laser trabeculoplasty, or minimally invasive glaucoma surgery (MIGS); trabeculectomy is for advanced or refractory cases.

Is trabeculectomy painful?

No, performed under anesthesia; mild discomfort for 1–2 weeks, managed with medication.

How soon can I resume activities?

Light activities in 1–2 weeks; normal routines in 2–4 weeks; full recovery in 4–6 weeks.

Is trabeculectomy covered by insurance in India?

Yes, for medical necessity; confirm with your provider.

Signs of complications?

Sudden vision loss, severe pain, redness, or discharge.

Will my vision improve after trabeculectomy?

The goal is to preserve vision, not improve it; vision improvement depends on pre-existing optic nerve damage.

Lifestyle changes post-surgery?

Avoid rubbing the eye, use prescribed drops, avoid contact sports, monitor IOP regularly, and attend follow-ups.

Conclusion

Trabeculectomy is an effective procedure for managing advanced glaucoma, lowering IOP to preserve vision with a good success rate. India’s top hospitals (Apollo, Fortis, AIIMS) provide affordable, expert care, typically covered by insurance. Understanding the procedure, costs, recovery, risks, and FAQs helps patients approach surgery confidently. Consult a glaucoma specialist for personalized guidance and optimal outcomes.

Looking for Best Hospitals for Trabeculectomy

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we are not promoting any hospitals we sourced all the details from google and hospitals website, please verify and start with your surgery here we go the list includes government, budget and superspeciality hospitals accreditation bodies are the National Accreditation Board for Hospitals and Healthcare Providers (NABH) and the Joint Commission International (JCI)

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City	Minimum Price (₹)	Maximum Price (₹)
Agra	30,000	80,000
Ahmedabad	50,000	1,00,000
Ajmer	30,000	80,000
Aligarh	30,000	80,000
Allahabad	30,000	80,000
Amritsar	40,000	90,000
Aurangabad	40,000	90,000
Bangalore	50,000	1,00,000
Bareilly	30,000	80,000
Belgaum	40,000	90,000
Bhopal	40,000	90,000
Bhubaneswar	40,000	90,000
Bikaner	30,000	80,000
Chandigarh	50,000	1,00,000
Chennai	50,000	1,00,000
Coimbatore	50,000	1,00,000
Dehradun	40,000	90,000
Delhi	50,000	1,00,000
Dhanbad	30,000	80,000
Durgapur	30,000	80,000
Faridabad	50,000	1,00,000
Ghaziabad	50,000	1,00,000
Gorakhpur	30,000	80,000
Guntur	40,000	90,000
Gurgaon	50,000	1,00,000
Guwahati	40,000	90,000
Gwalior	30,000	80,000
Hyderabad	50,000	1,00,000
Indore	40,000	90,000
Jabalpur	30,000	80,000
Jaipur	50,000	1,00,000
Jalandhar	40,000	90,000
Jamshedpur	40,000	90,000
Jodhpur	30,000	80,000
Kanpur	30,000	80,000
Kochi	50,000	1,00,000
Kolkata	50,000	1,00,000
Kollam	40,000	90,000
Lucknow	40,000	90,000
Ludhiana	50,000	1,00,000
Madurai	40,000	90,000
Mangalore	40,000	90,000
Meerut	30,000	80,000
Moradabad	30,000	80,000
Mumbai	50,000	1,00,000
Mysore	50,000	1,00,000
Nagpur	40,000	90,000
Nashik	40,000	90,000
Navi Mumbai	50,000	1,00,000
Noida	50,000	1,00,000
Patna	30,000	80,000
Pune	50,000	1,00,000
Raipur	40,000	90,000
Rajkot	40,000	90,000
Ranchi	30,000	80,000
Surat	50,000	1,00,000
Thane	50,000	1,00,000
Vadodara	40,000	90,000
Varanasi	30,000	80,000
Visakhapatnam	40,000	90,000

Disclaimer

This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.