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Advice on Trabeculectomy

Question:

I’ve had two trabs – one on the left eye in November and one on the right eye last month.  The left eye went very smoothly.  The second one had some complications, but nothing we can’t get through, I hope 8-) The left eye kept closing up, so the gs gave me three treatments of 5F-U to prevent bleb closure.  My pressure is at 8, just where he wanted it. The right eye had a bleb leak so the trick was to bring the pressure *up* after surgery!  Because of the bleb leak, I’ve also got macular edema, which should resolve over time. I’m 54 years old, considered "young" for a trab (oh, how I love that!). I’m in the Seattle area, so can’t help you with a recommendation, but through the University, I bet you’ve got a great doc! I already had a cataract in the left eye prior to surgery and the gs noticed one in the right eye last week.  They do tend to form after a trab, but they’re easy to take care of!  Infection is the biggest worry.  I’ve never had an eye infection in my life, so I’m hoping that since I’m not prone to eye infections, it won’t be a problem for me. The surgery doesn’t make your eye more at risk for infection, it just makes an infection very dangerous to that eye. The only other surgery is trabeculoplasty, which isn’t effective in younger patients. If you want some *great* info, go to http:www.wills-glaucoma.org Good luck with your surgery! Sherry "Selim Tuvi" <se…@yahoo.com> wrote in <4jpM6.1903$Uj6.4…@open-news.pacbell.net>: <snip> >on. He recommends that I have Trabeculectomy done. >Although he says that it is a common operation I am a little worried >due to my age. I read that with younger people the incision tends to >heal quicker. Also what is the risk of infection and cataract? Are >there any other less risky operations that I should try first before >resorting to Trabeculectomy?

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Response:

  Hi everyone, I just discovered this group and I am hoping to find some answers. I am a 36 year old male diagnosed with pigmentary glaucoma. My doctor says I have moderate nerve damage, although I haven’t experienced any vision loss yet. I am on three drops right now, Cosopt, Alphagan and Lumigan. Initially my pressure was around 40, now due to using the drops it is down to around 25. I had laser iridotomy on both eyes, which initially decreased my pressure to around 15 but after couple of weeks it went up again. My doctor says that the drops that I am using will not likely to reduce my pressure further and if I don’t have surgery I am risking blindness later on. He recommends that I have Trabeculectomy done. Although he says that it is a common operation I am a little worried due to my age. I read that with younger people the incision tends to heal quicker. Also what is the risk of infection and cataract? Are there any other less risky operations that I should try first before resorting to Trabeculectomy? I have the highest respect for my doctor (Dr. Shan Lin from UCSF) but I am also planning to get a second opinion. If you know any highly recommended glaucoma specialists in the San Francisco Bay area I appreciate it if you can let me know. Thank you all in advance for your time and will look forward to your responses. -Selim

Response:

Hi Selim: Dr. Robert Ritch responds: "Pilocarpine Ocuserts are my drug of choice for PG if there is no retinal problem. However, the company is unfortunately discontinuing production of these. There are several good glaucoma specialists in the Bay area." – Hide quoted text — Show quoted text -"Selim Tuvi" <se…@yahoo.com> wrote: >  Hi everyone, I just discovered this group and I am hoping to find some >answers. I am a 36 year old male diagnosed with pigmentary glaucoma. My >doctor says I have moderate nerve damage, although I haven’t experienced any >vision loss yet. >I am on three drops right now, Cosopt, Alphagan and Lumigan. Initially my >pressure was around 40, now due to using the drops it is down to around 25. >I had laser iridotomy on both eyes, which initially decreased my pressure to >around 15 but after couple of weeks it went up again. >My doctor says that the drops that I am using will not likely to reduce my >pressure further and if I don’t have surgery I am risking blindness later >on. He recommends that I have Trabeculectomy done. >Although he says that it is a common operation I am a little worried due to >my age. I read that with younger people the incision tends to heal quicker. >Also what is the risk of infection and cataract? Are there any other less >risky operations that I should try first before resorting to Trabeculectomy? >I have the highest respect for my doctor (Dr. Shan Lin from UCSF) but I am >also planning to get a second opinion. If you know any highly recommended >glaucoma specialists in the San Francisco Bay area I appreciate it if you >can let me know. >Thank you all in advance for your time and will look forward to your >responses. >-Selim

Response:

Selim,      Your actions so far seem correct to me.  I haven’t had a trabeculectomy, but reading here have seen many testimonials to its effectiveness, and very few serious complaints (some minor ones about post-op meds, etc.).  I’m pretty sure if I were in your shoes I’d go for it, particularly if all those drops weren’t taking my pressures below 25.    Good luck,    Don Singleton – Hide quoted text — Show quoted text -Selim Tuvi wrote: >   Hi everyone, I just discovered this group and I am hoping to find some > answers. I am a 36 year old male diagnosed with pigmentary glaucoma. My > doctor says I have moderate nerve damage, although I haven’t experienced any > vision loss yet. > I am on three drops right now, Cosopt, Alphagan and Lumigan. Initially my > pressure was around 40, now due to using the drops it is down to around 25. > I had laser iridotomy on both eyes, which initially decreased my pressure to > around 15 but after couple of weeks it went up again. > My doctor says that the drops that I am using will not likely to reduce my > pressure further and if I don’t have surgery I am risking blindness later > on. He recommends that I have Trabeculectomy done. > Although he says that it is a common operation I am a little worried due to > my age. I read that with younger people the incision tends to heal quicker. > Also what is the risk of infection and cataract? Are there any other less > risky operations that I should try first before resorting to Trabeculectomy? > I have the highest respect for my doctor (Dr. Shan Lin from UCSF) but I am > also planning to get a second opinion. If you know any highly recommended > glaucoma specialists in the San Francisco Bay area I appreciate it if you > can let me know. > Thank you all in advance for your time and will look forward to your > responses. > -Selim

Response:

In article <4jpM6.1903$Uj6.4…@open-news.pacbell.net>, "Selim Tuvi" – Hide quoted text — Show quoted text -<se…@yahoo.com> wrote: >   Hi everyone, I just discovered this group and I am hoping to find some > answers. I am a 36 year old male diagnosed with pigmentary glaucoma. My > doctor says I have moderate nerve damage, although I haven’t experienced > any > vision loss yet. > I am on three drops right now, Cosopt, Alphagan and Lumigan. Initially my > pressure was around 40, now due to using the drops it is down to around > 25. > I had laser iridotomy on both eyes, which initially decreased my pressure > to > around 15 but after couple of weeks it went up again. > My doctor says that the drops that I am using will not likely to reduce > my > pressure further and if I don’t have surgery I am risking blindness later > on. He recommends that I have Trabeculectomy done. > Although he says that it is a common operation I am a little worried due > to > my age. I read that with younger people the incision tends to heal > quicker. > Also what is the risk of infection and cataract? Are there any other less > risky operations that I should try first before resorting to > Trabeculectomy? > I have the highest respect for my doctor (Dr. Shan Lin from UCSF) but I > am > also planning to get a second opinion. If you know any highly recommended > glaucoma specialists in the San Francisco Bay area I appreciate it if you > can let me know. > Thank you all in advance for your time and will look forward to your > responses. > -Selim

* During the past year, I have hed trabeculectomies in both eyes — performed at the Palo Alto Clinic.  My ophthalmologist was Dr. Mary Ann lloyd. I was first diagnosed with common open-angle glaucoma in 1970, when I was 39 years old.  I was on drops for the past thirty years. My pressures are now around 17/18 — my central visual acuity (corrected) is 20:20.  I have had cataract surgery in both eyes. Good luck, earle *

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