|
Pre-Operative Evaluation
You will need a note
from your/your childās 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
childās particular case. WITHOUT SURGICALLY LOWERING THE PRESSURE
THRE IS VIRTUALLY NO CHANCE FOR VISION TO DEVELOP in some childrenās
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 parentsā 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 childās
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.
 |
