Trabeculotomy in Moscow – microsurgical surgery for glaucoma
With glaucomatous optic neuropathy, the optic nerve fibers are gradually damaged. Vision may remain normal for a long time, so the disease is not always noticeable in its early stages.
At "K+31," we discuss surgery only after a full diagnosis. The patient receives a clear explanation, not a general recommendation: what has been found, how stable the condition is, and why the doctor is recommending this particular approach.
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Indications and limitations for trabeculotomy
Not every patient with high blood pressure needs glaucoma surgery. Sometimes, medication or laser treatment is sufficient. If the condition progresses, the doctor will discuss glaucoma surgery.
When we recommend surgery
Indications are assessed on an individual basis. Surgery is most often discussed in the following cases:
- Insufficient response from glaucoma drops
- Persistent increase in pressure during treatment
- Changes affecting the optic nerve
- Anatomical features of the anterior chamber angle
- The need to strengthen disease control
After assessing the indications, the doctor clarifies the patient's general medical conditions, previous surgeries, response to medications, and the expected benefit of the procedure.
When choosing a different treatment method
Sometimes the trabecular meshwork or Schlemm's canal prevent the desired effect from the chosen technique. In this case, a different type of glaucoma surgery is chosen.
General information
How We Perform Trabeculotomy
Before the procedure, it's important to understand the anatomy of your specific eye. We evaluate:
- Cornea
- Anterior Chamber
- Crystal Lens
- Retina and Visual Function
Repeat pressure measurements are performed if necessary. This helps determine the target level and avoid making decisions based on random results.
Preparation for the Procedure
Preparation begins with an in-person appointment. Doctor:
- Measures blood pressure
- Conducts a slit lamp examination
- Evaluates the fundus
- Clarifies the medical history
The plan may include gonioscopy, perimetry, optical tomography, and repeat measurements at different times. Glaucoma treatment is based on these data.
If the patient is taking medications for the heart, blood vessels, or blood clotting, this should be disclosed in advance. Glaucoma drops should not be discontinued on your own. The regimen is changed only as prescribed by an ophthalmologist. This procedure reduces the risk of pressure surges before the procedure.
What type of anesthesia do we use?
The surgery is performed under general anesthesia. The type of anesthesia depends on:
- The extent of the procedure
- The condition of the eye
- The patient's age
- Concomitant factors
There is usually no significant pain, but a sensation of light, touch, or pressure from instruments may be felt. These sensations are discussed in advance during the consultation.
Main stages of the surgery
Microsurgery of the eye requires precise work in a small area. The ophthalmic surgeon gains access to the drainage area, locates the Schlemm canal, and exposes the area obstructing the flow of fluid. The main goal is to improve the outflow of intraocular fluid without unnecessary tissue trauma.
Glaucoma surgery technique may vary from patient to patient. Sometimes the procedure is performed alone, while other eye surgeries may be combined.
Frequently Asked Questions
Before surgery, it's important for patients to understand what to expect. The most common questions are whether it will hurt, how the recovery will be, and what results to expect. We discuss these issues in advance, before the procedure. Having clear information helps patients prepare calmly and avoid anxiety about the unknown.
Is trabeculotomy painful?
How long does recovery take?
How does trabeculotomy differ from other glaucoma surgeries?
Can vision be preserved after surgery?
When should you book a consultation?
Glaucoma can develop for a long time without any obvious symptoms. A person can read, drive, or work on a computer without noticing that the optic nerve is already under increased strain. Therefore, it's best to have visual function checked before obvious limitations appear.
A consultation is necessary if elevated intraocular pressure has been previously recorded, there is a hereditary predisposition, age-related risks, or changes in examination data. The sooner the doctor sees progress, the more accurately the stage of the disease can be determined, the risk of vision loss can be assessed, and treatment can be selected without unnecessary delay.
What is the first appointment like?
During the initial appointment, the doctor will clarify your complaints, measure your blood pressure, examine the anterior segment of the eye, evaluate the fundus, and, if necessary, prescribe additional tests. Sometimes observation and therapy are sufficient; sometimes glaucoma surgery is discussed.
If glaucoma treatment is required, we select it based on the examination findings, not just one symptom. If surgery is needed after the appointment, the doctor discusses the timing, preparation, and follow-up visits. The patient understands in advance what tests have already been performed, what information is still needed, and what will happen after the procedure. This approach reduces anxiety and helps them experience a calmer treatment experience.
What symptoms should not be ignored?
Reasons for seeking medical attention include:
- Narrowed field of vision
- Blurring
- Eye pain
- Rainbow halos around lights
- Frequent changes of glasses without an obvious reason
You should see a doctor immediately if you experience a sudden deterioration in vision, severe pain, nausea, severe redness, or a feeling of fullness in the eye.
References
- Clinical guidelines of the Ministry of Health of the Russian Federation — https://cr.minzdrav.gov.ru/
- N.N. Helmholtz Institute of Ophthalmology — https://helmholtzeyeinstitute.ru/
- RMJ — ophthalmology section — https://www.rmj.ru/articles/oftalmologiya/
- EyePress — professional ophthalmology portal — https://eyepress.ru/
- eLIBRARY — scientific publications on the topic — https://www.elibrary.ru/
- Russian Society of Ophthalmologists / specialized materials on glaucoma — https://www.eyepress.ru/ and https://cr.minzdrav.gov.ru/
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What is trabeculotomy and how does it help with glaucoma?
Trabeculotomy is a microsurgical procedure aimed at improving the natural outflow of fluid from the eye. Because of this, intraocular pressure remains above a safe level for a given patient.
The procedure reduces the strain on tissues that are essential for maintaining vision. This method does not restore lost fibers, but it helps slow further damage.
How we restore the outflow of intraocular fluid
Normally, fluid passes through the trabecular meshwork, then enters the Schlemm canal, and then drains through drainage pathways. If this area is not functioning properly, pressure becomes elevated or unstable.
During the procedure, the surgeon opens the area of resistance to facilitate the movement of fluid. This allows the outflow of intraocular fluid to proceed more freely.
When is this method particularly appropriate?
This method is considered for forms of the disease where the potential of the natural drainage pathway is preserved. Therefore, trabeculotomy in Moscow is not prescribed based on a single blood pressure reading. We look at the entire clinical picture, not just a single reading.