Maximising the success of trabeculectomy: the moorfields safer surgery system

ABSTRACT

Trabeculectomy is the procedure of choice for lowering intraocular pressure when topical treatment has failed. Improvements in techniques have reduced the risks of complications such as infection, hypotony and bleb failure. The increased use of antifibrotic agents such as 5-fluorouracil [5FU] and Mitomycin C [MMC] potentially increase the risk of some complications as well as maintaining lower intraocular pressures. In this article we discuss a step by step approach to trabeculectomy surgery and highlight simple steps in the procedure which have recently been modified to improve outcomes. This includes information regarding anaesthesia, careful choice of the surgical site, fashioning of the scleral flap and application of antimetabolites to produce diffuse aqueous flow, maintenance of intraocular pressure, a formed anterior chamber with outflow control during surgery using an infusion, adjustable sutures, and corneal-conjunctival closure techniques