Trabeculectomy with suprachoroidal derivation
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Although trabeculectomy has evolved over time, fibrosis remains the main enemy of success, and the shape and vulnerability of the blebs, an obstacle to comfort and long-term safety. For this reason, we modified the conventional trabeculectomy by directing the aqueous humor flow to the suprachoroidal space by means of a specially created canal, without the use of any artificial space-maintaining device and preserved by the patient’s own scleral tissue. The aqueous humor drains from the trabeculectomy into the tunnel and, eventually, part of the aqueous can also drain to an external bleb. External blebs, if present, should not be prominent.
We carried out a retrospective, ultrasound biomicroscopy (UBM) study of 18 eyes of 14 patients whose surgery with the modified technique was successful in the long term (a minimum of two years follow-up). Average follow-up time was 42.94 months, median: 47 months. The most frequent UBM finding was an evident suprachoroidal anechoic space in 88% of the eyes. In 63.5% of these, the space was classified as extensive. One-third of the eyes (six) had no ultrasonographic evidence of an external bleb. Blebs tended to be shallow and diffuse. The average final intraocular pressure was strikingly low (12.66 ± 2.49 mmHg, median: 13 mmHg), as was the complication rate, with no devastating complications.
New Concepts in Glaucoma Surgery Series: Volume 1, pp. 249-253 #18
Edited by: John R. Samples and Iqbal Ike K. Ahmed
© Kugler Publications, Amsterdam, The Netherlands
Video 1. Demonstration of the trabeculectomy with suprachoroidal derivation surgical technique
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