Small incision trabeculectomy: experiences with this new procedure for glaucoma surgery in Indian eyes

Abstract

The purpose of this study was to evaluate the potential advantages and disadvantages, success rate and complications of this new procedure for glaucoma surgery, which includes the formation of a filtration fistula without any dissection of the Tenon's capsule; as an alternative to trabeculectomy with or without pharmacological wound modulation. Small Incision Trabeculectomy avoiding Tenon's capsule was performed in 40 glaucomatous eyes through a 2.5 mm limbal incision and intraocular pressure was monitored serially over a period of 12 months. The mean postoperative intraocular pressure (16.60+/-5.93 mmHg) at 12 months follow-up was significantly lower than the mean preoperative IOP (30.20+/-10.70 mmHg). Thirty-six eyes (90%) had IOP less than 22 mmHg without antiglaucoma medications at the end of the 12-month follow-up. Blebs were pale and diffusely elevated. No serious complications were encountered. This new technique is a low-cost and safe alternative to conventional trabeculectomy that effectively reduces intraocular pressure. The use of a small 2.5 mm incision which obviates the dissection of the Tenon's capsule and subsequent subconjunctival fibrosis, the absence of requirement of any sophisticated instruments, and the absence of any major complications which are encountered with the use of anti-metabolites entails that this procedure be performed more often in glaucomatous eyes needing filtration surgery.