Late complications of surgical glaucoma treatment
Last reviewed: 23.04.2024
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In most cases, antiglaucomatous filtering operations are effective in reducing intraocular pressure, are safe, but not always flawless. Many unsuccessful outcomes of filtering operations are caused by technical errors or undesirable reactions during reparative processes. At the present time, new methodical and safe surgical technologies are being created in order to change the biological response in order to minimize some undesirable 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 antiglaucomatous filtering operations and discuss possible treatment strategies. Some of the antiglaucomatous therapeutic strategies have passed the test of time and are widely used in practice. With the help of modern procedures and their alternatives, one or more authors individually solved problems. More recent and rarely used methods have not yet been thoroughly tested and time tested.
Factors affecting wound healing
- Impeccable and precise surgical technique
- The use of antimetabolic drugs
- The etiology of glaucoma development (uveitis or neovascularization)
- Use of anti-inflammatory drugs in the postoperative period
- Other biological factors (heredity, age and race)
Undesirable outcomes with a pronounced or inadequate reparative process
- Expressive reparative process
- Violation of filtration due to scarring
- Insufficient filtering
- Encapsulation of the filter cushion
- Insufficient reparative process
- Hypotension
- Choroidal detachment
- Folds in the macula
- Small camera
- External filtration
- Infiltrations of the filtration cushion
- Giant filter cushions
Hypotension leads to the development of maculopathy, choroid detachment and distant suprachoroidal hemorrhages. Hypotension often results from an insufficient resistance of the scleral flap, which, after trabeculectomy performed with antimetabolics, requires a lot of repeated flashing of the flap. There are alternative methods of treatment. In cases with the use of antimetabolites, when a rapid result is needed, for example, in patients with a small anterior chamber, maculopathy or with "kissing choroid blisters," such methods are less effective. With a necrotically altered scleral flap with hyperfiltration, the seams may not provide sufficient counteraction to the outflow. Then, to achieve the desired strength, a "roof" is formed from a flap of donor tissue. In each case of scleral flap revision or restoration of a filter cushion, it is recommended to have donor tissue at hand.
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