This audio article is from VisualFieldTest.com. Read the full article here: https://visualfieldtest.com/en/personalizing-a-supplement-plan-after-trabeculectomy Test your visual field online: https://visualfieldtest.com Support the show so new episodes keep coming: https://www.buzzsprout.com/2563091/support Excerpt: Personalizing Your Post-Trabeculectomy Diet and Supplements After a trabeculectomy (glaucoma surgery), your eye is healing through several stages. In the first 2–4 weeks, new blood vessels and soft granulation tissue form under the conjunctiva () (). By about 3 weeks, collagen and scar tissue begin to develop. During this subacute phase (2–4 weeks), the bleb (fluid-filtering bubble) is still soft and vascular (). Good nutrition helps healing: a balanced diet rich in fruits, vegetables, vitamins (like C and A), protein, and fluids supports tissue repair () (). However, very high-dose or specialty supplements generally show only modest benefit () (). For example, a clinical trial found that taking 300 mg of vitamin E daily after trabeculectomy did not improve surgical success or complication rates compared to placebo (). Instead of relying on megadoses, follow your doctor’s orders for eye drops and medication. Use supplements only if needed and in safe doses. This means usually not exceeding the Recommended Daily Allowance for vitamins/minerals unless a deficiency is known. Discuss any new supplement with your doctor before starting. Consider Your Medical History and Medications Your overall health can affect healing and interactions with supplements: Blood thinners or anticoagulants (like warfarin, Xarelto, aspirin, Plavix): These make bleeding more likely. Many herbal supplements also have blood-thinning effects. For example, garlic, ginkgo biloba, ginger, ginseng, turmeric (curcumin), and high-dose vitamin E can all increase bleeding risk () (). One review found that garlic and hawthorn supplements were strongly linked to surgical bleeding, and that herbs like ginkgo, turmeric, and others raised bleeding risk in patients on blood thinners (). If you take any of these, tell your doctor. He or she may suggest stopping them or monitoring you closely. On the other hand, normal-dose fish oil (omega-3), ginseng, and saw palmetto did not show increased bleeding in studies (), though we still caution if you are on blood thinners. Practical point: If you are on warfarin, your doctor should check your INR after starting any new supplement. For example, substances like vitamin E or CoQ10 can raise INR and require a dose adjustment (). Vitamin K (in green vegetables) lowers warfarin effect, so keep your vitamin K intake steady. Blood pressure, heart meds, and kidney meds: Some supplements affect blood pressure or potassium levels. For example, potassium-rich supplements or teas (like high-dose potassium or warm medicinal teas) can add to potassium if you’re on ACE-inhibitors or potassium-sparing diuretics. Herbals like licorice can also raise blood pressure. Always check with your doctor: if you have high blood pressure or heart disease, do not take supplements that significantly raise or lower blood pressure without approval. Diabetes: If you have diabetes, avoid supplements that spike blood sugar. Some herbal formulas (like certain Chinese or Ayurvedic mixes) can raise or lower blood sugar, so discuss any new herbals with your endocrinologist. Generally, stick to multivitamins and avoid sweet syrups or products with lots of sugar. Other conditions: Chronic inflammatory conditions or steroid use can slow healing or suppress immune response. In these cases, your doctor may want to avoid immune-boosting herbs (like echinacea) or anti-inflammatory ones (like high-dose turmeric) that could theoretically interfere with your medications. If you have liver or kidney problems, high doses of fat-soluble vitamins (A, D, E, K) or minerals might need lab monitoring. Bottom line: Write down all your health conditions and medications. Review them with your doctor to flag any supplement interactions. For instance, if you use aspirin or warfarin, your doctor will advise stopping “blood-thinning” herbs well before or after surgery (). Surgical Details Matter Details of your surgery guide what to watch for: Anti-scarring agents (MMC/5-FU): Many trabeculectomies use anti-fibrotic drugs (mitomycin-C or 5-fluorouracil) during surgery to prevent aggressive scarring (). If your surgeon used these, the wound is intentionally kept from scarring too fast. In that case, you may tolerate normal healing better and have less natural scarring. You usually do not need extra anti-scarring supplements, since the medication already reduces fibrosis. No anti-scarring agents: If no mitomycin-C or 5-FU was used, your eye relies on its own healing. Certain types of glaucoma, like neovascular or uveitic glaucoma, or repeat surgery cases, are known to scar excessively and often drive surgeons to use anti-fibrotics (). In these high-risk eyes, supplements that might inhibit scarring (like curcumin) could be considered, but evidence is weak. It’s safer to ensure good steroid use (as prescribed eye drops) and a healthy diet rich in anti-oxidants (fruits, vegetables) () () rather than special pills. Needling or leaks: If in follow-up the doctor performed a needling procedure (to break scar tissue) or there’s a bleb leak, it means your eye is having trouble. In such cases, avoid any supplement that could worsen bleeding or fluid leaks. Focus on healing (adequate rest, avoiding strain). For example, if your bleb is leaking, keep eyes lubricated and avoid thickening supplements that dry out fluids; also notify your surgeon before adding anything new. Assess Healing Status At two weeks, your surgeon will examine the bleb. Here’s what to consider for supplements: Bleb appearance & fluids: If the bleb is very vascular (red) or has a tiny leak, skip blood-thinning supplements (fish oil, ginkgo, garlic, etc.) until it’s stable. The aim is to avoid new minor hemorrhages around the surgical site. Intraocular pressure (IOP): Keep track at each visit. A slight upward trend in IOP during the first month could signal scarring (). Avoid supplements that might raise IOP (some people worry about caffeine or certain steroids; check with doctor). Conjunctival and wound health: No serious infection or inflammation should be present. If your eye shows signs of infection (redness, discharge) or excessive inflammation, do not take new supplements that you haven’t used before the surgery. Contact your doctor right away. Weighing Bleeding vs. Fibrosis Risks Weigh your risk of bleeding complications against risk of scar formation: High bleeding risk: This includes patients on blood thinners, with bleeding disorders, or those who had a bloody operative course. Also older patients can have more fragile vessels. In high bleeding-risk cases, be cautious with any supplement that thins blood. For example, a Baylor University review cautions that many supplements can “alter bleeding and coagulation during surgery” (). Garlic and hawthorn were “strongly associated” with surgical bleeding, and others (ginkgo, turmeric, fenugreek, etc.) posed risks in patients on anticoagulants (). If you fall into this category, skip herbals like ginkgo/ginseng/ginger and stop any high-dose multivitamins or fish oil until your doctor gives clearance. Your doctor may even suggest stopping non-essential supplements 2 weeks before and after surgery (). High fibrosis (scarring) risk: Younger patients, Black or African ancestry, and patients with inflammatory glaucoma (like uveitic) or prior failed trabs tend to scar more () (). If you’re in this group, your doctor likely already used an antifibrotic medicine. Still, you can support healthy healing: ensure enough protein (but not extreme “bone broth”), stay hydrated, and possibly use mild anti-inflammatories (see below). There’s no proven supplement that mimics mitomycin, but maintaining a healthy diet of fruits and vegetables (vitamins A, C) and omega-3 fatty acids can modulate inflammation. Safe Supplements to Consider When healing is on track and risk factors are managed, these may be safe: Basic vitamins/minerals: A standard multivitamin (100% of daily values) is fine if your diet is poor or you have a known deficiency. Vitamins C and A are important for collagen and tissue repair; vitamin C deficiency especially delays healing (). However, don’t take mega-doses. For example, excess vitamin A can be toxic – stick to normal amounts. Zinc: An essential mineral for wound repair. Zinc serves in cell growth and immune function. Studies show zinc deficiency is linked to delayed healing (). If you’re deficient (or diet poor), a modest zinc supplement (e.g. 8–11 mg daily) can be helpful. But high-dose zinc can cause nausea or anemia, so don’t overdo it. Omega-3 (fish oil): These fatty acids help resolve inflammation. Some research in wound care notes omega-3s have “profound effects on wound healing” (). Small doses (e.g. 1000 mg fish oil daily) can be safe and may calm inflammation around the bleb. Large doses may thin blood slightly; if you’re on blood thinners, check with your doctor. Large trials have found no significant bleeding risk from normal fish oil use () (), but caution is wise with any anticoagulant use. Arginine: An amino acid involved in collagen production and immune function. Some wound-healing protocols include arginine to support tissue growth. There’s no specific study in trabs, but a review notes arginine (with omega-3s) can improve wound outcomes (). You might get Support the show
