Trabeculectomy
improvements
When many of us think
about glaucoma sur-
gery, we think about
trabeculectomy. Until
about 15 years ago,
that was our bread-
and-butter approach.
Glaucoma occurs
because the channels
that allow aqueous to
flow out of the eye
become less efficient.
This procedure, like most, is aimed at correcting that problem.
Trabeculectomy involves opening the conjunctiva, dissecting the
sclera and then making an incision under a scleral flap, into the anteri-
or chamber and removing a piece of the peripheral iris to allow fluid
to flow out. Our "Gold Standard" procedure is about as elegant as
drilling a hole in the side of a bathtub and placing a bucket next to it
to collect the water.
When it works, it can work well, but sometimes pressure drops too
much, resulting in a potentially devastating condition called hypotony.
The conjunctival bleb can scar down, stopping outflow. Also, because
there's an open communication, these patients are at lifelong risk for
endophthalmitis. Trab-eculectomy patients also take as long as 3
months to heal.
In the early 2000s, Optonol (later bought by Alcon) introduced the Ex-
Press, a tiny stainless steel shunt that made trabs somewhat better.
Instead of relying on a passageway made of tissue, the Ex-Press allows
4 6 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • M a r c h 2 0 1 7
• ALCON'S CYPASS stent uses a different outflow pathway than the iStent, let-
ting you implant both in a single eye.
Matt
Poe-www.OphthalmicPhotography.Info
