N. Douglas Baker, MD, reviews some of his surgical strategies for avoiding complications after trabeculectomy or a glaucoma tube procedure.
Reviewed by N. Douglas Baker, MD
Complications after glaucoma surgery include a number of different entities—and for each, there is variety of potential causes as well as preventive strategies. N. Douglas Baker, MD, discussed issues relating to site of the trabeculectomy filtering bleb and of the tube location in cases of drainage device surgery.
“I used to think my trabeculectomy procedure was successful if it effectively achieved a low IOP,” said Dr. Baker, in private practice at Ophthalmic Surgeons and Consultants of Ohio, Columbus. “It is also important, however, to create a comfortable bleb, and that requires keeping the aqueous filtration site 3 mm to 4 mm posterior to the limbus.”
He outlined several measures that will help direct aqueous fluid drainage posteriorly and avoid formation of a thin elevated bleb. Dr. Baker explained that he creates a larger scleral flap (5 mm at the limbus and 3 mm at the apex of a trapezoidal configuration). He also recommended suturing the scleral flap with tighter horizontal limbal sutures and leaving the posterior sutures looser.
“For postoperative suture lysis, the posterior sutures should be cut first in order to encourage posterior aqueous filtration,” Dr. Baker said. Achieving meticulous closure of Tenons at the limbus is also valuable.
Dr. Baker said he places three or four episcleral bites nasally when doing the conjunctival and Tenons closure to prevent nasal extension of the filtration bleb. He added that by design, subconjunctival minimally invasive glaucoma surgery devices direct fluid posteriorly and promote formation of a flat limbal bleb.
N. Douglas Baker, MD
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This article is adapted from Dr. Baker’s presentation at the 2019 American Glaucoma Society annual meeting. Dr. Baker is a consultant to Molteno and Santen.