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Familiar trabeculectomy remains most popular glaucoma surgical option
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LAS VEGAS — Despite the development of other surgical approaches for lowering IOP, trabeculectomy remains the most popular choice among ophthalmologists because of several key advantages, according a presentation here.
The presentation was compiled by John C. Morrison, MD, but presented by Claude F. Burgoyne, MD, during Glaucoma Subspecialty Day preceding the American Academy of Ophthalmology meeting because Dr. Morrison was unable to attend.
The first advantage of trabeculectomy is its efficacy. When performed with adjunctive antifibrotic agents such as mitomycin-C (MMC), trabeculectomy can achieve IOPs lower than surgery alone for several types of glaucoma, including open-angle glaucoma, pseudophakic glaucoma and some secondary glaucomas, Dr. Burgoyne said.
The second advantage is its flexibility; trabeculectomy can be modified to improve pressure control and to increase safety. Surgical modifications include titrating the use of antimetabolites based on the perceived need, preventing MMC exposure to tissues and choosing between a limbus-based or fornix-based conjunctival flap. For high-risk eyes, safety can be improved by creating larger or thicker flaps to reduce the extent of pressure reductions.
The rate of postoperative IOP reduction can be controlled using laser suture lysis or releasable sutures, Dr. Burgoyne said
Finally, trabeculectomy is a repeatable procedure, and failed surgeries can be revised. Scarred blebs can be needled at the slit lamp and revised with antimetabolites, he said.