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Trabeculectomy
Glaucoma
Key Points
- •Trabeculectomy is the gold standard incisional glaucoma surgery - creates a fistula from AC to subconjunctival space through a guarded scleral flap
- •Antifibrotic augmentation with MMC (0.2–0.5 mg/mL for 1–5 minutes) is essential - without it, failure rates are unacceptably high due to subconjunctival fibrosis
- •The TVT study showed trabeculectomy + MMC and Baerveldt tube shunt had similar 5-year outcomes; the TAGS trial showed trabeculectomy was superior to medical therapy for IOP control
- •Bleb-related endophthalmitis is the most serious late complication - cumulative lifetime risk 5–7%; patients need lifelong vigilance for symptoms
- •Cataract progression is the most common long-term complication, occurring in 50–78% at 5 years (AGIS/CIGTS)
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- Definition
- Epidemiology
- Aetiology and causes
- Pathogenesis
- Classification
- Risk factors and associations