How to increase scarring after trabeculectomy

[CurioK]

My husband (30m) had a trabeculectomy in his left eye in August 2023. It is now November 2023 and the IOP is only up to 7. His vision in that eye has never recovered (it does temporarily if he does something a little strenuous like walking up a steep hill).

The consultant has said that to prevent permanent loss of sight they need to have another operation to add a stitch and increase the pressure. He will have another pressure test soon to decide if this is the case. In a perfect world this wouldn’t happen because he’ll have to be without any anaesthetic (he will have numbing drops) so will be awake during the procedure and is understandably very keen to not have to experience that.

Basically my question is, is there ANY lifestyle changes he can make to encourage scarring in the trab? He trusts the consultants know best and will ultimately follow their advice but if there is anything that he can do we would love to hear it

[Longwalks3]

Has the doctor explained why your husband can't have any anaesthetic apart from numbing drops? I am curious about this. Having said that, I had similar problems to your husband after a trab done 5 years ago. I had several major revisions to try and heal a leaking bleb and consequent low pressure. I won't repeat the whole story BUT ultimately a solution for my eye was found and 5 years on my pressure is stable and the vision in that eye is pretty good (I already had damaged fields on diagnosis so it's by no means perfect). If your husband really does need only one stitch then numbing drops really may be enough, awful though this sounds but you really should question it if it is causing anxiety.

[CurioK in reply to Longwalks3]

Thank you for your reply! Apparently because the pressure is already low the anaesthetic might make it drop too much and cause the retina to detach.

The anxiety is more around the fact that he will still be able to move his eye if it is only numbing drops, which can ruin the procedure. The advice from the doctor was “well don’t move your eye” which didn’t build much confidence! Apparently most patients are able to keep still but it feels like far too much responsibility 😬

I think it might be a few stitches so they can reduce them if required in the future.

Can I ask how long your revision procedures took?

Thank you again and glad to hear your pressure is under control!

[Longwalks3 in reply to CurioK]

I think the first one took about an hour - they put in about 10 stitches. The issue in my case was that I am very myopic and this makes the tissue very thin apparently. Also, after many years of glaucoma drop use the tissue was very damaged and fragile. I think the truth is that we are all different and it is very difficult to compare cases. I am very sorry that your husband is not getting more sympathetic care from his surgeon.

[CurioK in reply to Longwalks3]

Thank you, yes it really does seem like no two journeys are the same.

[Eahldt]

I had a stitch after my trabeculectomy because the pressure was too low. It solved the problem. I’m not sure about just numbing drops as I had a local anaesthetic. Maybe query this as my procedure took a while.

[CurioK in reply to Eahldt]

It is encouraging to hear that this solved the issue! He is hoping that this will be the last hurdle for now.

[Eahldt in reply to CurioK]

I hope so too. Give him my best wishes.

[KayGeeBee]

Is your husband still taking steroids (e.g. dexamethasone) following the August op? If he is then from what I've been told after my Preserflo ops the eye may still scar further as they are tapered and even after they have stopped?

How high does the consultant want the IOP to be as 7 doesn't seem extremely low from what I've been told (mine are about 8 and 6, the latter borderline acceptable), but maybe the consultant has noted that it is too low for your husband's particular eye? Waiting further to see what happens, as you say is going to happen, seems good to me, but I'm a patient not a medic.

Also, in my experience, vision can change a lot in the months following an op and exercise like walking can alter things quite quickly until the eye eventually settles down, in six months or more. I had to go back to Specsavers for a re-test as my eye changed between a test and having had the new glasses for only a couple of weeks. (They were replaced gratis). The eye has changed further, now at 10 months, and it needs a new prescription which I'll get when I get the other eye tested following its op. In the meantime I have bought reading glasses from Poundland with different strengths but with the same frame design, and I swap the lenses around to suit, with one pair for reading, another for computer and a third for distance. It's a cheap and fun way to cope with ever-changing vision until the eyes settle!

[Nonswimmer in reply to KayGeeBee]

Hi, I have normal pressure glaucoma, had a trab on my left eye in 2010 pressure raised to 23 so the trab was needled the trab worked well keeping pressure to 8/9 until 5 years ago when the pressure dropped to 4/5 my consultant had said the way to close the trab in a cornea graft which is the use a donor patch this is a two hour operation under general anaesthetic, has anyone heard of this please?

[Littletreasures]

I was interested to read your post as I am experiencing something similar. I had my surgery a short while before your husband. My eyesight was very foggy at first but has improved a little and I can now see although it’s very blurry. My pressure in that eye is 4. My consultant had mentioned stitches (there was no discussion about anaesthetic so I took it as a given that it would be anaesthetised ) but then changed his mind when I was hesitant and said the low pressure didn’t matter. I dont think well on the spot and didn’t ask why. I don’t have anyone to talk to about it so finding your post is such a relief knowing I’m not the only person this has happened to. I think a question your husband should ask his ophthalmologist is, will the pressure increase on its own if given time? My next appointment is in a few weeks and that’s a question I will ask.

[CurioK in reply to Littletreasures]

Thank you for your reply, since I first posted this he did have the extra stitches and they decided to give him some kind of numbing injection - he said the procedure wasn’t too bad in the end!

Apparently the reason for no anaesthetic was just that they didn’t have any anaesthetists available but needed to get him in ASAP. This is because the low pressure caused changes in his macular that might have become permanent - so waiting wasn’t a good option in his case. The pressure is now up to 15 which the consultant is happy with.

Best of luck on your trab recovery, I hope it’s all going well.