Glaucoma Surgery

PRE-OPERATIVE EVALUATION

You will need a note from your/your child’s medical doctor before admission to the hospital. Please bring this with you.

Laboratory work may or may not be needed. This will be done if necessary the day before or the morning of surgery.

Sometime in the afternoon on the day prior to surgery you will be contacted by the hospital. The time of the last feeding prior to surgery will be reviewed. This will depend on the age of the patient and the time of the surgery. The importance of an empty stomach prior to anesthesia will be emphasized. All food and fluid will need to be held after a certain hour.

PURPOSE OF THE SURGERY

The operation will attempt to lower the pressure inside the eye in order to prevent damage to the optic nerve and other structures of the eye. The doctor will do this by attempting to create a drainage canal in the eye(s). Depending on the clarity of the cornea this will be accomplished by an incision in the white of the eye (trabeculotomy) or by a direct incision into the canal via the cornea (goniotomy).

The development of the visual system and of good vision is dependent on a sharp, clear image focused in the eye during the early stages of childhood growth. It is impossible to assure that this development will occur in each child’s particular case. WITHOUT SURGICALLY LOWERING THE PRESSURE THRE IS VIRTUALLY NO CHANCE FOR VISION TO DEVELOP in some children’s particular cases.

RECOVERY ROOM

Following surgery the patient is taken to the recovery room where special nurses and equipment are available. Here the recovery from anesthesia is supervised. When a satisfactory state of consciousness returns, the patient is sent to a separate room. The family can rejoin the patient at this time.

POST-OPERATIVE COURSE

Eating: Until the patient is well awake nothing by mouth should be encouraged. Once awake, the patient may have ice chips or small sips of a beverage. Nausea may occur after the administration of anesthesia. Large quantities of food should be avoided in the immediate post-operative period as they can irritate the stomach. Usually the patient is able to resume a regular diet the day following surgery.

Bandages: The operated eye will be covered will a soft metallic shield. It is important that this shield stays in place overnight to prevent rubbing. Rubbing can cause the stitches to open, which in turn can cause leakage of the normal fluid contents of the eye. In addition to structural damage this can cause infection. This shield will be removed in our office the following day at the checkup. It is common to see blood inside the eye after glaucoma surgery. This will gradually clear on its own and is NOT an indication of active bleeding.

Tearing: Tearing may occur the first few days after surgery. If it is bothersome, they can be gently wiped away with a tissue or other soft material like a towel.

Pain: Generally there is little or no pain. The eyes may be sensitive to the light due to inflammation. Over the counter medications such as Tylenol or Advil are usually sufficient. Only very rarely are prescription pain killers needed. If severe pain associated with tearing is present, you should contact the surgeon immediately.

Activity: All patients are allowed up with supervision the same day. Infants and small children may be held in the parents’ arms. Swimming and contact sports are not permitted for four weeks. Keep soap and water out of eyes while bathing.

Glasses: The eyes may be light sensitive following surgery. In this case, older patients will appreciate sunglasses or wide-brimmed hats. Younger patients may choose to close their eyes to avoid the light. If glasses are worn before surgery, they will probably be continued immediately after surgery. They may be modified at some time during the post-operative period.

Medications: After surgery eye drop medications are required. Antibiotic drops are used to prevent infection. Steroid drops are used to calm inflammations. A dilating drop is used to assist in pain control. These will be gradually lessened over several weeks, but at least several weeks of drop therapy can be expected. Additional medications to control the intraocular pressure may be added.

Office visits: Generally the first checkup is on the next day following surgery. The eye patch is removed. Regular visits will then be scheduled at regular and frequent intervals. If there is any problem between scheduled visits, it should be reported and additional visits can be arranged.

LONG-TERM COURSE

Treating the child after the surgery is of the utmost importance in the final visual outcome. This treatment will continue until the visual system is mature, sometime BETWEEN FIVE AND TEN YEARS OF AGE. The expected treatment will probably include contact lenses and/or special glasses, use of a patch over one eye, and close medical supervision. More surgery may well be needed. All this treatment is in addition to the present cataract surgery. General medical problems may well require additional care from other medical specialists. In spite of all this extended treatment, the final vision in the operated eye may not be good even though the eye itself appears normal and all the medical advice has been carefully followed.

RISKS

Each child’s particular case will be discussed with the surgeon(s). If a decision for glaucoma surgery is made, it is the first step in the attempt to lower the pressure in the eye(s). There is no guarantee of good sight and there is a risk of poor or no sight following the surgery. Problems of bleeding, infection, future glaucoma, retinal detachment, or reaction of the tissue in the eye (inflammation) could even lead to complete loss of the eye. These are recognized risks that can occur after glaucoma surgery. Risks of anesthesia will be discussed as a separate issue.