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I.
II.
III.
IV.
V.
VI.
Indications for Trabeculectomy
A.
Progression despite maximally tolerated medical therapy (MTMT)
B.
Scottish and Moorfield’s Trials
C.
CIGTS
D.
AGIS
E.
Noncompliance
Preoperative Considerations
Trabeculectomy – brief procedure overview and goals
Post-Operative Medications
A.
Anti-inflammatory
B.
Antibiotics
C.
Cycloplegics
Postoperative Evaluation
A.
Cornea
B.
Conjunctiva
C.
Bleb
1.
Diffuse or localized
2.
Thick- or thin-walled or encysted
3.
Vascularity
4.
Elevation
5.
Seidel’s
D.
Anterior Chamber
1.
Inflammation
2.
Hyphema
3.
Hypopyon
4.
Depth
E.
Iris
1.
Shape
2.
Pupil
3.
Patency of iridotomy
4.
Hemorrhage
F.
Lens
G.
IOP
1.
Before and after digital massage
H.
Retina/Choroid
1.
Hypotonous maculopathy, folds, epiretinal membrane
2.
Hemorrhages
3.
RD or tear, choroidal detachment or suprachoroidal hemorrhage
Postoperative Complications
A.
Hypotony
1.
Causes
a.
Eye rubbing
b.
Longer antimetabolite application time
c.
Glaucoma medication use
d.
Aqueous hyposecretion
e.
Cyclodialysis cleft
f.
Choroidal detachment
g.
Overfiltration
h.
Wound leak – conjunctival or flap
i.
Inflammation/iritis
2.
Management options
a.
Injection of visco or air
b.
Pressure patch and decrease steroids for healing
c.
Bandage soft contact lens with caution
d.
Shell
e.
Autologous blood injection for large leaks
f.
Chemical Cautery – TCA
g.
Cyanoacrylate
h.
Tissue Glue
B.
C.
D.
E.
i.
Laser bleb revision
j.
Cryotherapy
k.
Suture
l.
Surgery
m.
Aqueous suppressants
n.
Monitor
Flat Anterior Chamber
1.
Causes
a.
Hypotony
b.
Choroidal detachment
c.
Aqueous misdirection
d.
Pupil Block
e.
Suprachoroidal hemorrhage
2.
Management
a.
Reform with BSS, air or visco
b.
Monitor
c.
Cycloplegics
Increased Intraocular Pressure
1.
Causes
a.
Aqueous misdirection
b.
Pupillary block
c.
Suprachoroidal hemorrhage
d.
Choroidal detachment
e.
External or internal obstruction
f.
Encapsulated bleb
g.
Tight scleral sutures
h.
Retained viscoelastic
i.
Hyphema
j.
Aggressive healing
2.
Management
a.
Ocular/Digital massage
b.
Laser suture lysis
c.
Antimetabolite Injection
d.
Needling
e.
Diathermy
f.
Surgical Revision
g.
Monitor
h.
Cyclo and increase steroids
i.
Aqueous suppressants
j.
Hyphema management
Infection
Cataract