Abstract
Guarded filtration surgery (ie, trabeculectomy), introduced by Sugar and Cairns, remains the procedure of choice for the majority of patients with glaucoma. Antimetabolites, 5-fluorouracil (5-FU) and mitomycin C (MMC), allow wound healing modulation and an individualized approach to modify the inflammatory/fibrotic response to the surgical insult. Despite advances in operative technique guarded trabeculectomy augmented by antimetabolites can have significant complications such as hypotony, suprachoroidal hemorrhage, choroidal effusions, hypotony maculopathy, bleb leak, blebitis, bleb encapsulation, failure, and endophthalmitis. These complications are partially attributed to the contradictory concepts of traditional glaucoma surgery: prevention of wound healing around the surgical fistula and inhibition of fibrosis of Tenon capsule to sclera on one hand and normal tissue repair of the overlying delicate conjunctiva to maintain the functional and anatomic integrity of the bleb constituting an adequate barrier against infection on the other.
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