Trabeculectomy with Mitomycin C

Anesthesia Implications

Position: Supine, arms tucked, Bed turned 90 degrees
Time: 30-60 min (short)
Blood Loss: Very Low (5-10 ml)
Post-op Pain: Minimal (1-3)
Maintenance Paralytic: No
Blocks: Retrobulbar

Preop – 0.5 – 2.0 mg versed in preop.

Approach – If the surgeon is using topical LA to anesthetize the conjunctiva, the versed is typically enough sedation. If the surgeon is doing a retrobulbar block, the patient will need to be deep beforehand. Most commonly this is accomplished using 20-60mg propofol or 500-750 mcg alfenta.

Oversedation – do not over sedate the patient – snoring will be amplified in the surgeon’s microscope.

Tucked Arms (general considerations): Consider a second IV – once the procedure has started, it’s going to be VERY difficult to handle IV issues – especially if your only IV has problems. Ensure the IV is running and monitors are still functioning after tucking the patient’s arms

Trabeculectomy is used as a treatment for closed and open-angle glaucoma. It decreases Intraocular pressure. It is performed when medical treatments or laser surgery can’t effectively lower the pressure inside the eye.

The surgeon will begin by using topical LA or an retrobulbar block to anesthetize the eye. The surgeon will then create a flap in the sclera under the upper eyelid. This is followed by creating a pathway under the flap for fluid to drain. The drainage will decrease eye pressure.

Postoperatively, if the area scars, drainage may fail. To prevent this excessive scarring, the surgeon will apply an antimetabolite such as 5-fluorouracil (5-FU) or mitomycin C (MMC) at the beginning phases of the surgery. This substantially reduces the risk of failure.

This procedure is effective 60-80% of the time.