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Late complications of surgical treatment of glaucoma

 
, medical expert
Last reviewed: 08.07.2025
 
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In most cases, antiglaucoma filtering surgeries are effective in reducing intraocular pressure, are safe, but not always perfect. Many unsuccessful outcomes of filtering surgeries are caused by technical errors or adverse reactions during reparative processes. New methodical and safe surgical technologies are currently being developed to change the biological reaction to minimize some adverse outcomes. Despite the successes achieved, remote complications may occur.

The purpose of this chapter is to review some of the most common delayed complications after antiglaucoma filtering surgery and to discuss possible treatment strategies. Some of the antiglaucoma treatment strategies have stood the test of time and are widely used in practice. Modern procedures and their alternatives have been used by one or more authors individually to solve problems. Newer and less commonly used methods have not yet been thoroughly tested and proven over time.

Factors Affecting Wound Healing

  • Impeccable and precise surgical technique
  • Use of anti-metabolic drugs
  • Etiology of glaucoma development (uveitis or neovascularization)
  • Use of anti-inflammatory drugs in the postoperative period
  • Other biological factors (heredity, age and race)

Adverse outcomes with pronounced or insufficient reparative process

  • Expressed reparative process
  • Impaired filtration due to scarring
  • Insufficient filtration
  • Encapsulation of the filtration pad
  • Insufficient reparative process
  • Hypotension
  • Choroidal detachment
  • Macula folds
  • Small camera
  • External filtration
  • Filter pad infections
  • Giant filtration pads

Hypotony leads to maculopathy, choroidal detachment, and distant suprachoroidal hemorrhage. Hypotony often results from insufficient scleral flap resistance, which requires multiple re-suturings of the flap after trabeculectomy performed with antimetabolites. Alternative treatments exist. In cases where antimetabolites are used and a rapid result is required, such as in patients with a shallow anterior chamber, maculopathy, or “kissing choroidal bubbles,” such treatments are less effective. In necrotic scleral flaps with hyperfiltration, sutures may not provide sufficient resistance to outflow. A “roof” is then formed from a flap of donor tissue to achieve the desired strength. In each case of scleral flap revision or filter pad reconstruction, it is recommended to have donor tissue on hand.

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