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Ask Dr. A.S. Desai Your Own Question
Dr. A.S. Desai
Dr. A.S. Desai, Ophthalmologist
Category: Eye
Satisfied Customers: 2436
Experience:  MS Ophthalmology with 13 years of surgical expereince
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I am originally from Peru but live in the US for many years;

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I am originally from Peru but live in the US for many years; my entire family, including my mother lives in Peru.
Not too long ago, my mother was diagnosed with Glaucoma. I am not exactly sure what type, but after 3 to 4 months of treatment, she was told by more than one doctor that she needed to go through a trabeculectomy surgery to control the pressure in both eyes.
It’s been 8 weeks now since she has had the surgery in the right eye and she has been complaining of some pain that she’s been feeling in her eye since the day of the surgery. It comes and goes and it’s sharp. She also complained about something inside her eye bothering her; as if she had an eyelid hair inside. Is this normal?
She also initially reported that her vision was blurry immediately after surgery, but three to four weeks after she was impressed at how much clearer she was able to see. Just last week her vision started to decline though, she said that now her vision is back to post-surgery levels. Is this normal after a trabeculectomy?
Lastly, she has developed since the surgery a small sponge like formation, in an entirely different area of the incision in the eye since the surgery. So, for example when she cries the tears stick to this area
(the formation is in lower area of the eye) and it doesn't allow to see her well. What could this be? She didn't have this before.
I would appreciate your answers. She is very anxious about her condition; she is older and lives alone and only speaks Spanish. She has gone to her surgeon, but doesn't remember everything and she is not either too inquisitive.
Submitted: 7 years ago via Glaucoma Research Foundation.
Category: Eye
Expert:  Dr. A.S. Desai replied 7 years ago.

Welcome to Just Answer

Do you mean that there is a sponge like tissue at the lower part ( between lower lid at lower margin of the colored part of the eye)? Do you find any raised tissue in the upper part of the white of the eye ( better seen if you lift the upper lid)?

Was any mention of cataracts developing in her eyes?
Customer: replied 7 years ago.
Thanks for your prompt response. Yes, she went to 4 specilists and even though they mentioned that she did have a minor case of cataracts, 3 of them agreed that she didn't need to address it at this time. The 4th one though, wanted to do a surgery facotrabeluctomy. I guess it is a trabeculectomy that also address the cataract issue?

Could that sponge like tissue be a cataract? developing this fast after the surgery? iS this the reason why her vission is deteriorating? it's not even be 8 weeks after the surgery...

I appreaciate your help.
Expert:  Dr. A.S. Desai replied 7 years ago.
Thank you for the reply and additional information.

The sponge like tissue is not likely to be a cataract because cataract is in the centre of the eye ( seen as a greyish white color in the pupillary area). It is common for cataracts to progress within weeks after trabeculectomy especially in pre-existing immature cataracts. One of the possibility for the vision deteriorating after trabeculectomy surgery is a progression of pre-existing cataract. In such a case the cataract can be surgically removed and an intraocular lens can be placed ( vision usually becomes better after this).

In glaucoma there is raised intraocular pressure ( IOP ) usually which causes optic nerve fibres to get degenerated resulting in reduced vision which is irreversible though further damage can be prevented by trabeculectomy surgery.

In the usual protocol followed all over the world, trabeculectomy is one of the last options , done when medical line of therapy fails. The first line of therapy is usually anti-glaucoma medicines which are tried initially with one drug , then multi drug regime for 6 months atleast before a failed medical line of treatment is diagnosed. The next option is argon laser trabeculotomy . When all these methods fail then surgical line of treatment is considered. In your mother's case I feel that the percentage of optic nerve fibres affected must have been quite high and that is why surgical line of treatment was considered. In such a case post-trabeculectomy no improvement in vision is to be expected . This surgery aims at retaining the existing functional fibres and residual vision. A cataract occuring in such cases will decrease vision further but its removal will improve vision only to some extent .

I'm afraid I will not be able to exactly tell what the spongy tissue is at the lower part of the eye without a proper eye exam. A feeling of hair like object in the eye may be due to sutures put in the trabeculectomy incision ( sometimes releasable sutures are left long too). This sensation will sibside over a period of time as sutures are not removed completely at times.

Thanks and best wishes

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Expert:  Dr. A.S. Desai replied 7 years ago.
phacotrabeculectomy is a surgery in which both cataract removal and glaucoma surgery are done together and is decided upon the density of cataract along with the glaucoma status.