Trabeculectomy completed, results are in, and short term gains clear. But long term, this is still a work in progress.

7 days post op

Visited the hospital and the doctor only took a quick look into the eye to check the surgery site, and said that progress was normal. He also said that the pressure was very low. When questioned further, he said that it would be less than 10, which is indeed very low. I asked how he could know this without actually doing a pressure test, and he informed me that the cornea in the front of the eye appears wrinkled. This accounts for the blurry vision that I am experiencing and, when you think that it is only the intraocular pressure that maintains the form of the front of the eye, it is easy to understand. Right now, my eye is like a balloon that is almost completely deflated. As the vent heals a little, the pressure will come up again, and this effect will go away.

10 days post op

I have another appointment and the doctor said that he would be removing some stitches in the next visit that are part of the trabeculectomy. I asked about if the pressure was expected to rise before then. He said that it probably would not. This was interesting, as I thought that the stitches would not be removed unless the pressure rose first. He told me that the stitches are a foreign body in the eye, and needed to be removed as they only cause irritation, and that this is the normal procedure. The pressure is still expected to rise over time, and I guess that if that is too much, then it will be back to the glaucoma medications again to keep it within acceptable levels. Of course, I should not have to return to the levels of medication that I was on prior to the operation. For now, it is very much a “wait and see” situation. No matter what happens, I am very confident that it has been successful and will be better for the long term.

14 days post op - Stitches out

This time is the time that the doctor was to take out the stitches but not in the way that I had expected at all. I received drops into the eye every 5 minutes for half an hour. These are anesthetic drops once again to cover the procedure of removal of the stitches, and I did think that I would then go up to the laser room for their cutting. However, instead I was sent to the normal examination room for him to remove two of the three stitches, and that this was to be cut and removed manually, just as it would be done from a cut anywhere else on your skin. It is very simple and easy so we got started. It took less than 2 minutes for him to cut and remove the stitches, and now have to return in a few days to have the last one taken out.

21 days post op

At the next visit then took a look at the site of the operation again, and then took the pressure reading, which showed that it was still only at 6, which is still very low. With this reading, he said that we should wait at least another week before doing anything further, as it may prove to be unnecessary to take out the last stitch, and the operation will have been successful enough as it is now. That is great news again, and I do think that I am getting to the end of this quite long episode, and should have now a nice long period without having to worry about this condition.

28 days post op

At this visit, the pressure reading was only up to 9, so that was about as good as it could possibly be at this stage. We do seem to have kicked a goal on this thing. Although still rather early it seems to be going as expected. I am still needing to use two types of eye drops, one an anti bacterial, and one a steroid to help with inflamation and to help with bringing the IOP back up to normal range. These medications have to be continued right up until the six weeks post op time.

Notes for things I did not know at this time

I was unaware at this time of a condition called hypotony which occurs when the IOP drops very low and remains very low for some time. Usually this would be lower than 5mm hg on a pressure scale. I was not made aware of this at this time, but seems it was unnecessary information since it was avoided by the doctor's procedures and careful management.

Hypotany did happen to me in my right eye but not until much later, 2024, which surgical procedures and post op complications did occur and which I will recount in later posts in this section of my site.

Go here to read more about hypotony: https://glaucoma.org/articles/hypotony

Six weeks post op

Being now the six weeks after the surgery and the pressure seems to be controlled really well, I can now relax a little about this problem. At this time, there is no need to put in any drops for either glaucoma or for the post operative treatment. Wonderful! This is the first time in many years that I don’t have to put drops in my eye. However...

An ominous sign for my left eye

Up until now, all my glaucoma problems have been in my right eye, and my left eye always normal. Howerver, at this time with all the check ups in the months following the right eye surgery, it was noted that pressure in my left eye read 24 on this visit. It is common for a case like mine to have the "fellow" eye to be affected in the same way at some time. The doctor has told me that he can see the pseudo exfoliation syndrome in my left eye and this is the start of the problem and suggested that perhaps we should start anti glaucoma drops for that eye now.

Given that two weeks ago the pressure in my left eye was only 12, I have decided not to start any medication and will wait another month and see how this plays out. If the pressure remains high I have the optino to act but hopefully this can be avoided for a lot longer. I will have to go to the hospital again in about one month. The decision not to start with glaucoma treatments in my left eye is entirely mine and against the advice of my doctor. But he is a doctor and he is not allowed to take any risks, no matter how minor they may appear. I made this decision based on my own observations and experience and know that the risk is mine alone. My reasons for delaying any start of the process for the other eye are twofold. First, I don’t see that a one off reading that is slightly high is so serious or sight threatening that I needed to immediately start a process that cannot be stopped, and second that I just wanted a holiday from eye medications after so many years of living with this problem. If there is any fallout from this decision, then I am the one who will have to live with the results, and I am fully aware of this.

3 months post op

The right eye now has a pressure of only 12 and the examination of that shows that trabeculectomy working really well and so we can be confident of a good result for the long term. However for the left eye, the pressure reading today is 21 . That is a little better than the last time, and shows no further progression of the problem there. Again, I decided not to start the medication because I know that once I start with that, it will not be possible to ever stop, regardless of how good it may get. Once started it would then be impossible to know if the pressure was okay by itself or if it was being controlled by the medication. I would prefer to allow it to go for a bit longer and just observe. I don’t feel that this is too dangerous as long as I keep it monitored.

4 months post op

I saw a different doctor today, and she advised me that for someone to have this problem unilaterally for a very long time is quite rare so again I am in a minority. The exfoliation material is now evident in my left eye, but not to any great extent. I am not particularly concerned at this stage because, although I know that this could well go on to be as serious as the problems that I have experienced with my right eye, I don’t think that it is going to happen any time soon.

Today the pressure was 12 in the right eye which is perfect and showing control by the trabeculectomy. The pressure in my left eye was 16 and that is also a really good result. It shows that while there is XFM there, and it does cause some small problem from time to time, it is not going into the range that it is problematic enough to warrant medicating. Until the syndrome evolves out further it will be okay as it is but of course, any prediction of a time frame is impossible.

5 months post op

The pressure in my right eye today is 14, good result. The pressure in my left eye is 17 which is also a great result, as it shows virtually no change since last time and satisfying for me to have been right to have refused to start with anti glaucoma medication in that eye as advised a few months ago. No criticism of the doctor here, he was also right, and it was simply that I took a risk and got lucky. It could have gone either way, and the doctors need to be pesimestic and cover all bases fully.

The big surprise news I received at this examination was that today that there is no sign at all of Exfoliation Syndrome to be observed in my left eye.

1 year post op

It is late March 2008 and the check went well, pressures of 16 in the right and 17 in the left and these normal levels of IOP being registered without any anti glaucoma medications. Now it is just wait and check ever 3 to 6 months assuming I did not become aware of any spikes of the occular pressure as I had experienced prior to my surgery the previous year.

First Serious Relapse - December 17, 2008

I became aware of a very high "attack" of IOP from my knowledge of how this "feels" while not painful, and also from the halos around lights that I can see which for me can only occur through a high IOP.

Upon having the ophthalmologist check the pressures, it was found that both eyes are showing a pressure of 38, way too high and causing damage without any doubt. This had to be controlled immediately to avert serious damage continuing. The action indicated was to take some of the diuretic called Diamox again as well as starting immediately on the glaucoma drops in both eyes to reduce the pressure.

Checking again the following day it was revealed that the trabeculectomy that was performed in June of the last year has healed over and is no longer able to relieve any pressure as it was designed to do. The only alternative seems to be to have another similar procedure performed in my right eye, and it may also be indicated for my left eye as some stage down the track. For the moment, it is wait and see, but it is a certainty that the struggle against this problem will go on for many years to come.

The next day, December 19th the news is a little better, and slightly more encouraging. As a result of the medications the pressures are reduced to almost normal levels which is a great relief. My left eye is down to 14 and that is about as good as it gets. The right eye though is at 21 and while this is good, it is a little higher than we would wish for to ensure no further damage done to the optice nerve.

QUESTIONS - What is actually going on here?

I asked a lot of questions, and came up with some new information about the condition. Last time, the pressure was 38 in both of my eyes, but I could see the halos only from my right eye giving me the impression that the pressure in that eye must have been higher. However, the explanation is simpler but not really good. Because of the damage to my optic nerve in my right eye only due to the condition over the long time to date, my pupil will dilate more to accommodate the lower sensitivity. The doctor says that he can clearly see this, and I have occasionally had people comment on this difference in the size of my pupils but I shrugged it off as just a natural and normal phenomena. Quite fascinating how the eye is able to make these automatic adjustments and accommodating the changing conditions and actually do that independently of eachother

18 months post op

It is now January 2009 and at the check up my left eye is seems okay with a pressure of 17. For the right eye, the one that has had the problem for all this time is also lowered at a pressure of 21. According to the doctor, this is still a little too high for this eye given the history and the damage already sustained. The target is to have the right medication to maintain a pressure below 20 and preferrably at around 16 for long term assurance that no further damage is done to the optic nerve. The action for the moment is to continue medication in both eyes with the Xalatan once every day in the evenings.

19 months post op

Getting nearer normal again. Pressure in the right eye is only 15 and in the left is down now to 13. These figures are great and a real relief but do deepen the mystery of how all this happens and what are the causes that should be treated rather than simply reacting to the results.

4 years post op

It is March 11, 2011 and I have been going along very well for almost two years and nothing happening and we all hopeful that it would stay that way. However, at a regular check up we discovered the pressure in my right eye was back up there at around 26 which caused a lot of concern. To check to see if there was any degeneration of my vision, the doctor ordered a field vision test.

Visual Field Test informaton here: https://glaucoma.org/articles/what-is-a-visual-field-test

MINIMAL LOSS OF VISION - To the amazement of my doctor, the field vision test showed that, in spite of all that I had been through and all the assaults on my optic nerves through serious rounds of high IOP, my vision loss as compared to a normal person was minimal! Perhaps I am one of the fortunate ones where my optic nerves are more robust and not easily degenerated by the high bouts of IOP. I relate it to the fact that I do not have sustained levels if high IOP, but that I have periodic attacks for a short time, but then normal pressures for longer in between periods.

However, the pressure in my right eye was starting to consistently show high, and something was going to have to be done. I really was not up to going through that full invasive surgical procedure of the trabeculectomy all over again and informed the doctor about that I was not optimistic about the positive results from that procedure anyway. Given that I had endured that process twice, and each time the benefit was temporary, I was hopeful that surgery could be avoided and we find a medication that would control things better.

Try the laser again

The suggestion was that we do the laser process again. The doctor advised that there had been advancements with the laser surgery that I had tried back in 2007 and that this new laser process was showing much better and more consistent results. Well, I was an easy sell given that it was not super expensive, not overly invasive, and quite painless.

I booked in for later that week, turned up, went through the process, and went home and hoped for the best. And so everyone’s relief, it did work well. That is, the pressure in my right eye became controlled and has remained controlled for the time since that was done.

Although I now put Xalatan drops in both eyes every day and a second medication drop in my right eye twice every day, the IOP is controlled, and latest tests have shown that it is all remaining under control. So, at the end of 2014, and my latest check up showing good results, I don’t have to return to the hospital until March next year.

Of course, this is only the end of this chapter, not the end of the story. Next post and a new culprit exposed? PS Syndrome?