What is trabeculectomy?

Updated: May 18, 2020
  • Author: Maria Hannah Pia Uyloan de Guzman, MD; Chief Editor: Hampton Roy, Sr, MD  more...
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Before the development of the trabeculectomy, the available surgical methods of intraocular pressure (IOP) reduction had a high rate of serious complications such as hypotony, flat anterior chamber and endophthalmitis. Thus, in an effort to improve the safety of IOP-lowering surgery, the guarded filtering procedure was developed. Cairns was the first to report success using the trabeculectomy in 1968. [1] Cairns' trabeculectomy, with some improvements and modifications at various steps, is still being performed today.

Trabeculectomy involves the creation of a fistula connecting the anterior chamber and the subconjunctival space. This provides an alternative method of aqueous humor filtration when the natural trabecular outflow pathway is blocked or poorly functioning in cases of glaucoma. The goal is to create the right amount of flow without causing overfiltration. Its success relies on the continued patency of the fistula and the continued ability of the filtering bleb created out of the conjunctiva to absorb aqueous. Thus, the success of the procedure lies not only on the surgical technique but also in the intraoperative and postoperative measures to modulate wound healing. See the image below.

Flow of aqueous after a trabeculectomy. Flow of aqueous after a trabeculectomy.

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