Sarwat Salim1. 1. Hamilton Eye Institute, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. ssalim@uthsc.edu
Abstract
PURPOSE OF REVIEW: Trabeculectomy continues to be the most effective incisional surgery for uncontrolled glaucoma. Since its introduction by Cairns in 1968, the procedure has undergone numerous modifications. This article will summarize the current variations of glaucoma filtration surgery and evidence-based review of their potential advantages and disadvantages. RECENT FINDINGS: Recent innovations in glaucoma filtration surgery have focused on wound modulation to enhance long-term surgical outcomes and the search for a small incision surgery with more predictable outcomes, lower complication rates, and rapid visual recovery. Amniotic membranes, antivascular endothelial growth factor agents, and tissue-engineered biodegradable implants are currently being investigated as alternatives to mitomycin C and 5-fluorouracil to reduce inflammation and subsequent bleb failure with fewer complications. The Ex-PRESS glaucoma filtration device appears promising with its unique feature of small-incision surgery, fewer intraoperative and postoperative complications, and its ability to lower intraocular pressure significantly, which appears to be comparable with standard trabeculectomy. SUMMARY: Knowledge and surgical expertise in handling current variations of glaucoma filtration surgery are essential to offer an individualized approach with the overall goal of optimizing surgical outcomes and minimizing complications.
PURPOSE OF REVIEW: Trabeculectomy continues to be the most effective incisional surgery for uncontrolled glaucoma. Since its introduction by Cairns in 1968, the procedure has undergone numerous modifications. This article will summarize the current variations of glaucoma filtration surgery and evidence-based review of their potential advantages and disadvantages. RECENT FINDINGS: Recent innovations in glaucoma filtration surgery have focused on wound modulation to enhance long-term surgical outcomes and the search for a small incision surgery with more predictable outcomes, lower complication rates, and rapid visual recovery. Amniotic membranes, antivascular endothelial growth factor agents, and tissue-engineered biodegradable implants are currently being investigated as alternatives to mitomycin C and 5-fluorouracil to reduce inflammation and subsequent bleb failure with fewer complications. The Ex-PRESS glaucoma filtration device appears promising with its unique feature of small-incision surgery, fewer intraoperative and postoperative complications, and its ability to lower intraocular pressure significantly, which appears to be comparable with standard trabeculectomy. SUMMARY: Knowledge and surgical expertise in handling current variations of glaucoma filtration surgery are essential to offer an individualized approach with the overall goal of optimizing surgical outcomes and minimizing complications.
Authors: Shivali A Menda; Eugene A Lowry; Travis C Porco; Robert L Stamper; Michel R Rubin; Ying Han Journal: Int Ophthalmol Date: 2014-06-12 Impact factor: 2.031