Trabeculectomy is an old operation — but it’s a very effective one, began Dr. Franz Grehn (Germany),
who co-chaired the session along with Dr. Eugenio Maul (Chile) Prevention and Management.
“We can have success with this operation if we can manage and avoid complications.”
According to Dr. Maul, trabeculectomy will remain the cornerstone of glaucoma surgery, at least for the next few years.
“Proper management in the postoperative period is what forges a glaucoma surgeon’s character,” said Dr. Maul ลาวสามัคคี.
So, what are some of the complications — and how are they best managed? This topic was explored in depth on Day 3 of the World Glaucoma e-Congress (WGC 2021).
Conjunctival leaks Assoc. Prof. Shamira Perera, from Singapore National Eye Centre, said that conjunctival leaks can occur intraoperatively (e.g., conjunctival buttonholes) and occasionally, they can also occur at the limbus.
“In our series, we found that bleb leaks are quite uncommon in both trabeculectomy and phacotrabeculectomy, and didn’t change whether the original disease was POAG or PACG,” shared Assoc.
Prof. Perera, adding that they remained around 1%. “Bleb leaks are important postoperatively because they can
be associated with bleb infection and eyes with bleb infection are 26x more likely to have a leak at the time of infection,” he continued.
Blebs, blebs and more blebs In trabeculectomy, if the drainage pathway is obstructed, bleb failure occurs — which results in postoperative IOP elevation, shared Dr. Masaru Inatani from the University of Fukui (Japan).
He then detailed how to manage a dysfunctional bleb, which covered bleb needling (and how to do it), reoperation and other tips.
One takeaway? An avascular dysfunctional bleb is a good indication for bleb needling because the needle easily approaches the scleral flap.
We recommend watching a replay of his talk for more on these key insights Prevention and Management.
Bleb dysesthesia — including its definition, symptoms, risk factors, pathophysiology and therapeutic approaches — was covered
by Dr. Tomas Grippo, Grippo Glaucoma & Cataract Center (Argentina). “It is an
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