Trabeculectomy: Does It Have a Future?

Abstract

The trabeculectomy (TRAB) procedure has undergone various modifications to increase the long-term surgical success and safety profiles. The main issues with TRAB include short and long-term complications, that are more common with the concomitant use of anti-fibrotic agents. While many surgeons have predicted the demise of trabeculectomy amidst newer non-penetrating glaucoma surgeries, it is still the gold standard procedure for patients with an advanced or rapidly progressing disease and for those patients who need very low intraocular pressures. This review article is unique in summarizing the evolution of trabeculectomy and its efficacy compared to neoteric shunt procedures while trying to predict if trabeculectomy has a future in the modern surgical world. We have compared the outcomes and complications of trabeculectomy to all the surgical procedures available to date and have tried to evolve an algorithm to help surgeons to decide on their preferred technique.

Keywords: glaucoma surgery; minimally invasive glaucoma surgeries; non-penetrating glaucoma surgery; phacotrabeculectomy; trabeculectomy.

Figure 1. Schematic diagram illustrating different surgical options for the treatment of glaucoma

Figure 2. Comparison of open glaucoma surgery versus minimally invasive glaucoma surgeries

A- showing intraoperative gonioscopic assisted transluminal trabeculectomy being done with 5-0 prolene suture through a needle track entry into the anterior chamber. B- shows ab-interno goniotomy. C- shows routine trabeculectomy being done that entails cutting open part of the trabecular tissue All images are from the corresponding author's own work.