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Implementing simple, easy-to-use tips can assist successful trabeculectomies
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HONG KONG — A large surface area of treatment and control of aqueous flow direction and amount are two surgical pearls for safe and effective trabeculectomy, a glaucoma expert said.
 Peng T. Khaw |
Prof. Peng T. Khaw, PhD, FRCP, FRCS, FRCOphth, FRCPath, FIBiol, FMedSci, shared clinical pearls from his experience performing trabeculectomies.
"These are simple changes that any surgeon can apply tomorrow in their clinical practice easily," Dr. Khaw said in an interview with Ocular Surgery News after his presentation at the World Ophthalmology Congress here.
In his presentation, Dr. Khaw outlined ways that physicians can achieve the most pressure-lowering from trabeculectomy with limited complications, based on clinical observations and published studies. He said the tips are simple and easy modifications to any filtration procedure and typically produce effective pressure-lowering results postoperatively.
In the interview, he said that implementing these pearls will enable patients to see well and experience improved comfort and fewer complications after filtration surgery.
He showed a video of a trabeculectomy procedure that he performed using a large treatment area, infusion, and a mixture of fixed and releasable sutures and a corneal conjunctival closure. He said using an infusion and choosing the right kind of suture are
key factors in achieving the best surgical results. Also, posteriorly directed flow, a large scleral flap not cut to the limbus and a single scleral punch sclerostomy can help in achieving safe, successful filtration surgery, he said.
Infusions are important because they provide tight control over the aqueous flow. Dr. Khaw said he always uses infusions in penetrating surgery. He showed in the video case how, after placing the infusion, he put in two fixed sutures for the high risk eye.
"It's very important when you're putting in these sutures that there's flow at this point," he said. "That's why infusion is important, because there's got to be a reasonable amount of flow because if there isn't, you won't be able to adjust the pressure down reasonably in the postoperative period."
He also used adjustable, half-thickness sutures, one on each side, to leave a bigger gap in the middle of the eye. After placing the sutures, he removed the infusion to ensure that the eye remained secure, he said.
"There's still flow at this point, and that's quite important because that will help you maintain the pressure around 20 mm Hg in the first postoperative days," Dr. Khaw said.
He also showed his corneal conjunctival closure technique, outlining how he typically places four small slits in the cornea. The technique produces an excellent secure closure, he said.