Trabeculectomy and antimetabolites
- Correspondence to: Mr Scott Fraser Sunderland Eye Infirmary, Queen Alexandra Road, Sunderland SR2 9HP, UK; sfraser100totalise.co.uk
Perfecting a technique that works takes practice, but it is getting increasingly hard to get this practice
When von Graefe first introduced iridectomy as a treatment for glaucoma, some practitioners noted that the patients who usually had persistent reductions in intraocular pressure (IOP) were those who developed an inadvertent filtering bleb at the site of the surgery. This led De Wecker,1 in 1882, to suggest that the IOP could be reduced by purposely creating a fistula between the anterior chamber and the subconjunctival tissues. He was the first to use the term “filtering” to describe this egress of fluid from the eye.2
Full thickness filtering procedures were used throughout the early 20th century but were bedevilled by a high rate of postoperative complications such as hypotony, flat anterior chambers, and suprachoroidal haemorrhage. For this reason, in the 1960s, a guarded filtration technique was developed and (incorrectly) named trabeculectomy.3,4 It is a tribute to this operation that it has, with certain modifications, persisted to the present day.
However, just as full …
