Ab-externo cyclodialysis enhanced trabeculectomy for intractable post-penetrating keratoplasty glaucoma

Innovations in glaucoma surgery from Dr. Rajendra Prasad Centre for Ophthalmic Sciences

Trabeculectomy surgery is the current standard of care in glaucoma for achieving a low target intraocular pressure if medical therapy is not adequate. Augmentation of trabeculectomy with antimetabolites brought a revolutionary change in the long-term success rates of trabeculectomy, but along with it came a plethora of complications. There still is a big window for therapeutic innovations on this subject. The foremost target for these innovations is to modulate the wound healing response after glaucoma drainage surgery. Achieving the desired balance between long-term success of filtering blebs versus early failure due to scarring of blebs and hypotony due to dysfunctional filtering blebs poses a unique challenge to the ophthalmologists. Alternatives to trabeculectomy such as glaucoma drainage devices and minimally invasive glaucoma surgeries cannot solve the problem of glaucoma blindness in our country, mainly due to their unpredictable results and unfavorable cost-benefit ratio. In this article, we present a summary of our innovations in glaucoma surgery to advance patient care by making it more effective, safer, and economical.

Cyclodialysis-enhanced trabeculectomy with triple Ologen implantation

PURPOSE

To describe a novel technique of trabeculectomy combined with cyclodialysis and Ologen implantation at 3 sites in cases with high risk for failure of trabeculectomy.

METHODS

Six eyes of 6 patients who had high risk for failure of trabeculectomy underwent cyclodialysis-augmented trabeculectomy with Ologen implantation at 3 sites using the described technique.

RESULTS

All the eyes achieved target intraocular pressure, which was maintained until 1 year of follow-up. One eye required bleb needling at 6 weeks postoperative follow-up. None of the eyes had any other intraoperative or postoperative complications.

CONCLUSIONS

This novel technique of combining trabeculectomy with cyclodialysis augmented by Ologen placement at 3 locations appears to have encouraging short-term intraocular pressure control and may be adopted in eyes with risk factors for failure of conventional trabeculectomy.