Improved trabeculectomy techniques help patients ‘dramatically’

SINGAPORE — Advances in trabeculectomy, including increasing bleb hole sizes and the advent of adjustable sutures, have made the surgery “unrecognizable compared with a few years ago,” Peng T. Khaw, MD, said. He outlined the system London’s Moorfields Eye Hospital uses here at the Asia-Pacific Academy of Ophthalmology meeting.

Using the most advanced proven techniques has helped Moorfields “dramatically reduce postoperative complications” such as blebitis, inflammation and endophthalmitis, Dr. Khaw said. As a result, the hospital has reduced the number of complications from about 20% to none, he added.

The improvements Dr. Khaw recommends include controlling the flow by directing it posteriorly, using a “much larger area” for the blebs and creating a 500 µm punch.

“You don’t need special machines for this, you just need a change in technique,” he said. “These are simple changes that people can make tomorrow.”

Adjustable sutures have also radically changed trabeculectomy, Dr. Khaw said. “It’s what we have been dreaming about,” he said, adding hypotony is significantly controlled.

Currently, there is about a 2% risk of hypotony at Moorfields, a decrease from about 25% before the use of adjustable sutures, he said. Other advantages to using the adjustable sutures are that they do not need to be removed and surgeons only need to place enough sutures until the flow is controlled.