Murdoch, I; (2006) How I approach trabeculectomy surgery. Community Eye Health , 19 (59) 42 -43.

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Abstract

The purpose of this article is to describe an approach to the most commonly performed surgical treatment for open-angle glaucoma, trabeculectomy. It is important to recognise that the concept of trabeculectomy surgery can be difficult for patients to comprehend in the first place. Their disease is frequently ‘thrust upon them’ by doctors; in other words, they are frequently asymptomatic in the eye that the ophthalmologist is most concerned about. The therapy, at best, can only hope to maintain vision. Vision may well deteriorate as a result of the therapy. These concepts are vital in the consideration of any surgical intervention. Preventive therapy is always more difficult to introduce. This also means the surgeon is all the more challenged to produce the safest possible result. A well-rested surgeon and a calm surgical environment is the start, along with a confident surgical technique. The purpose of trabeculectomy surgery is to create a guarded fistula through which aqueous can drain from the anterior chamber, leading to a steady-state reduced intraocular pressure. If this intervention is appropriate for a patient, drainage surgery has been demonstrated to give long-term intraocular pressure control and visual field preservation. The main complication of this procedure is a failure of drainage due to a scarring response. Other complications include hypotony (low pressure in the eye), infection, and haemorrhage. This article describes each step and lists points for you as a surgeon to consider. It is based on the assumption that the decision to operate is appropriate. What matters is your results. Follow-up of your surgery is vital so you know how successful your surgery is and can take steps to remedy the deficiencies you identify.

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