Trabeculectomy

ABSTRACT

In a critical review of trabeculectomy, some factors and steps which I consider to be of importance for its successful outcome are discussed. Trabeculectomy is a misnomer because its success does not depend on inclusion of trabecular meshwork or Schlemm's canal in the excised tissue. Furthermore, development of conjunctival bleb is seen in most, if not all eyes with successful trabeculectomy. Trabeculectomy is then a form of guarded filtering procedure. Several factors seem to determine the outcome of the final intraocular pressure control after trabeculectomy. Some of the factors are the tightness of closure of the lamellar scleral flap, the thickness of the lamellar scleral flap, the kind of sutures used for closure of the flap, the amount of cauterization applied to the scleral wound, and the size of the window defect relative to the size of the lamellar scleral flap. Trabeculectomy, as reported by others, seems to be a remarkably successful and safe procedure. It, however, is with disappointing results in aphakic glaucomas. Although we do not yet know how many of the eyes with seemingly successful trabeculectomy will remain so many years from the time of surgery, from all available indications at the present, trabeculectomy will stay with us as a primary procedure for open-angle and chronic angle-closure glaucomas in adult phakic eyes.