Dear Editor

We read with interest the report by Henderson et al.[1] The title of the paper includes the word "early" and the median time to leak is 3.5 days, but the range of time taken for bleb leakage to develop extends to 408 days postoperatively. We do not think this is early nor a postoperative complication.

Wound leakage complicates the management of trabeculectomy: some eyes develop anterior chamber shallowing, choroidal detachment and even hypotony, causing the clinician to intervene by a variety of methods. Whilst leakage is occurring subconjunctival fibrosis may proceed unchecked, but standard interventions, such as needling with injection of 5-fluorouracil, may be contraindicated in the presence of a wound leak. It would be helpful for the reader to know whether any interventions were needed or were delayed, since not only may these affect the long term outcome but also will help to guide the surgeon managing a wound leak.

Thank you for your clarification on these points.

Tom Askew
(MBChB student)

Mr Batterbury
(Consultant Ophthalmologist, FRCOphth)

Reference

1. H W A Henderson, E Ezra, and I E Murdoch Early postoperative trabeculectomy leakage: incidence, time course, severity, and impact on surgical outcome Br J Ophthalmol 2004; 88: 626-629.