Flap architecture, MMC play key roles in trabeculectomy

HONG KONG — Both flap architecture and mitomycin-C significantly affect bleb integrity and function, a glaucoma specialist said.

Keith Barton, MD, FRCP, FRCS, FRCOphth, spoke at the World Ophthalmology Congress here about flap construction and complications from trabeculectomy. He said filtration surgery has improved over the years and remains a viable and important surgical option in treating glaucomatous progression. He traced its evolution and safety profile from its inception to its current role as a standard option for controlling and lowering pressure.

"Filtration surgery is a continual trade-off between efficacy and safety," Dr. Barton said. "Moving from full-thickness to guarded trabeculectomy procedures improved safety but reduced success."

Studies have shown that trabeculectomy can be more successful than medical therapy in some glaucoma patients but that there are numerous complications, he said.

Dr. Barton said flap construction plays a role in bleb function because it is linked to the resistance and direction of aqueous flow. This role renders correct flap construction essential. In addition, he said MMC has helped bring trabeculectomy to prominence in glaucoma surgical options, but also has the potential for complications.

"Mitomycin-C actually can affect the ciliary body and can actually create hypotony of its own accord," Dr. Barton said. "It's important to be relatively careful about using mitomycin."