Trabeculectomy Without Conjunctival Incision

Abstract

A trabeculectomy technique with conventional instruments, but without conjunctival incision or intracameral manipulation, was completed in 12 eye-bank eyes, two cat eyes, and in five patients with glaucoma. A partial-thickness limbal corneal flap provided access to an intrastromal limbal pocket through which the subconjunctival space was entered with an irrigating cystotome. The anterior chamber was entered at the surgical corneoscleral limbus beneath the corneal flap and the peripheral iridectomy was completed without difficulty. Full-thickness or guarded limbal fistulas could be created. Guarded limbal fistulas were completed in five of five patients with glaucoma. The technique produced low-lying, diffuse filtration blebs that persisted throughout the three-month postoperative period and reduced mean intraocular pressure from 33 to 12 mm Hg. Corneal trabeculectomy holds promise as a method for a filtration operation that does not require conjunctival incision, intracameral manipulation, or costly technology.