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What is optic nerve?

by GoMedii Technologies Health Consultant

there are some nerves in the back of the eye which are connected to the brain, these nerves are called optic nerves. This optic nerve sends light signals to the brain. Through this images are formed in the brain which enables one to see objects. The optic nerve is made up of more than a million tiny fibers. When the fibers of this optic nerve start dying, then when looking like dark spots appear. These spots are so fine that they are not even noticed at once. But there is also such a situation that when the optic nerve gets damaged too much, then the eyesight goes away.

What is Trabeculectomy?

Friends, in very simple language, to get rid of glaucoma patients suffering from glaucoma is a surgical procedure which is done in the operation theatre. In this regard, Dr. Madhu Bhoot, a renowned Glaucoma Specialist and Consultant, Surgeon, Eye Hospital, Center for Sight, Preet Vihar, Delhi, says, “Trabeculectomy surgery is the best way to treat glaucoma. Through this surgery, another passage is created in the eye, allowing the fluid present in the eye to flow out so that the intraocular pressure due to the accumulation of fluid can be reduced”. Doctor. Madhu explained that “when the exit of the fluid present in the eye is blocked, then it keeps accumulating in the eye, which increases the intraocular pressure. Due to this pressure, the optical nerves start getting damaged”. Doctor. Giving another important piece of information, Madhu said that after recovery from trabeculectomy surgery, drugs are never needed again, otherwise, eye drops may have to be put for the whole life, yet there is no guarantee that the optic nerve will stop from getting damaged. Will go." We will give information about what happens in trabeculectomy surgery later. First, let us know what is ocular fluid and why trabeculectomy surgery is needed.

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What is eye fluid?

The fluid present, the stagnation of which increases the IOP, which is the cause of glaucoma, is called aqueous humor. It is called method or eye water in Hindi. It is produced by the ciliary body. The ciliary body is the part of the vascular organs of the eye that connects the choroid to the iris. The choroid, also known as the choroid coat, is the vascular layer of the eye, which consists of connective tissue, and lies between the retina and the sclera (sclera). A fluid called aqueous humor is transparent like water and similar to plasma but with a lower protein concentration. It leaves the blood vessels and fills the front and back chambers of the eye through the pupil, covering the lens from all sides. Then from the angle of the foreskin, its exclusion continues in the blood. Since blood vessels do not go to some internal organs of the eyes such as the lens, cornea, etc., this fluid does the work of providing nutrition to them and removing the fecal matter. It becomes necessary that this fluid continues to regenerate and continue to flow through the angle of the anterior lobe of the eye. If its formation stops and does not come out, then the IOP increases which is the main cause of glaucoma.

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Why is trabeculectomy surgery needed?

If glaucoma is confirmed after a thorough examination of the eyes, then the following options are adopted for its treatment

Eye drops - Initially, ophthalmologists recommend putting some eye drops in the eye to remove the accumulated fluid in the eye and control the IOP. In some cases, some side effects of the eye drops have been observed such as burning, stinging, and itching of the eyes, blurred vision, and increased heartbeat.

Laser Treatment - Laser surgery is the most popular and simple medical method for the treatment of glaucoma. In this method, the doctor uses a laser to remove the fluid from the eye so that more fluid can be removed easily and the IOP can be reduced and kept under control.

When it is found from periodic tests that eye drops and laser treatment are not reducing IOP and damage to the optic nerve continues, then doctors recommend trabeculectomy surgery because there is no other option. Saved.

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Preparations and Tests Before Trabeculectomy Surgery

It is planned before any surgery. Trabeculectomy surgery also requires a proper preparation. For this, the doctor takes the following information from the patient and is asked to conduct some tests –

1. First the eye is evaluated, a closer examination is performed, the size of the eye is measured and any pre-existing conditions in the eye are considered that may have caused it at the time of surgery or after surgery. Complications may arise.

2. Then the doctor takes detailed information about the patient's health, such as asking about diabetes, high blood pressure, asthma or any other disease.

3. If the patient is taking any medicine, then the doctor takes information about it and may be asked to leave some medicines for some time such as blood thinners.

4. Some medicines can also be modified such as medicines for diabetes and high blood pressure.

5. In diabetic case the patient may be asked to remain empty stomach for the surgery.

6. If the surgical procedure is to be done with General Anesthesia then the patient will be asked to remain empty stomach for 12 hours before the procedure i.e. not to eat anything for 12 hours before the surgery.

7. In case of local anaesthesia, it is advised to eat some light food 2 hours before the surgery.

8. Information about allergies is also taken from the patient.

9. Information is also taken about whether the patient is taking any supplement or not.

10. On the day of surgery the patient is asked to bring a family member or friend along so that all the formalities of the day of surgery can be completed and the patient can be taken home right after the surgery.

11. Since the patient can be kept in the hospital for more than a day, the patient is asked to bring clothes, slippers, medicines, inhaler etc. in addition to wearing a pair.

12. All jewelery is asked to come after taking off at home. No metal objects or jewelery should be on the body at the time of surgery.

13. Women are advised not to wear make-up and apply nail polish.

14. The patient is asked to put one eye drop in the eye for three days before the day of surgery.

15. The patient is asked to get the following tests done –

(i) Random blood sugar test

(ii) Urine routine and microscopic test

(iii) Electrocardiogram scan

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Procedure on the day of surgery

The procedure on the day of surgery is as follows –

1. The patient is called about two hours before the time of surgery so that some formalities can be completed and some tests can also be done.

2. A form is given which is called as consent letter, which is given by filling, signing. The patient allows the surgeon to perform the surgery through this consent form. It should be read and understood and signed.

3. The bill for the cost of surgery is also to be deposited.

4. In the eye to be operated on the patient, three or four times the medicine is injected at an interval of about 15-20 minutes.

5. After this, the patient's blood pressure and heartbeat are measured. If it is normal then surgery is done.

6. Then the patient is asked to wear a surgery costume. Then the medicine is injected into the vein through the cannula to reduce the pressure in the eyes.

7. After this, after checking the anesthesia, the patient is given anesthesia.

8. Then the trabeculectomy surgery procedure is started.

How is Trabeculectomy Surgery Performed?

1. Trabeculectomy is a surgical procedure performed in an operation theatre, for which anesthesia is given by injection. Regarding anesthesia, the doctor decides whether the patient is to be given general anesthesia or local anesthesia. In general anesthesia, the patient goes into deep sleep, he does not feel anything at the time of surgery. In local anesthesia, only the area of the eye is numbed. In this, the patient comes to know that he is being operated on but he does not feel any kind of pain.

2. After giving anesthesia to the patient, the surgeon cleans the eye to be operated on, and puts an instrument called a lid speculum to keep the eye open. Then a veil is put over the patient's face so that nothing is visible except the eye.

3. The surgeon then makes a hole in the eye near the upper eyelid and removes a small piece of tissue from the drainage area. Surgeons make holes in such a way that part of it is covered by a flap made of tissue from the sclera. The sclera is the opaque, fibrous and protective outer layer of the eye. Aqueous humour, the new opening of the fluid through the drainage passage, lifts the tissue with the flap and forms a bubble called a bleb, with the help of this the surgeon sees whether the fluid is oozing out or not. The surgeon then sutures the flap near the bleb so that the newly created drainage passage is not clogged. These stitches are removed after 15 days.

4. After this, applying for medicine on the surgery area, closing the eye, and covering it with an eye patch or shield, the tape is applied.

5. After this the patient is discharged from the hospital after half/half an hour. Some painkillers are given at the time of discharge so that the patient can get relief from pain and fever and some eye drops are prescribed. The patient is asked to come to the hospital the next day so that the blindfold can be removed and examined. Only after the bandage is removed, does the process of putting the eye drops begin.

Some post-surgery instructions/precautions

1. Surgeries, tell the person accompanying the patient about the medicines and eye drops, when and when to put the medicine in the eye.

2. After the blindfold is opened, the patient is asked to wear dark glasses for a few days.

3. Strict instructions are given to keep the eye away from water as there is a possibility of infection due to water getting into the eye. That is why the patient is asked to take a bath below the neck. Friends, a question arises here if an accident happens in someone's house or relative and the patient cries, what will be the effect on the eye? Doctor. Madhu gave a very good and logical answer to this that "tear is the water of the eye and not outside, so there will be no damage to the eye and no infection".

4. The patient is also asked to avoid steam.

5. Bending is also forbidden.

6. Don't lift weights

7. It is forbidden to go out for morning walk, exercise, sports etc. for two weeks.

8. Long journeys and driving are strictly prohibited. So take rest at home.

9. Use mobile phone sparingly. You can watch TV for a while that too from a distance.

10. Do not try to read forcefully, it puts stress on the eye undergoing surgery.

11. If the patient himself or any family member who is putting medicine in the eye, make sure that the hands are clean, for this wash hands thoroughly with soap or sanitize.

12. After putting the medicine in the eye, clean the eye very gently with a clean cloth, do not rub. At no time should the eye be rubbed by mistake. It would be better to use wipes to clean the eyes.

13. Keep taking the medicine regularly as per the instructions of the doctor and keep visiting the doctor from time to time to get checked because it takes about two months for complete recovery.

Trabeculectomy surgery time and cost

Trabeculectomy surgery takes about an hour and costs around 60 thousand to 70 thousand rupees.