TRABECULECTOMY Saleh Al Obeidan, MD Department of Ophthalmology King Saud University

INTRA OPERATIVE COMPLICATIONS ________________________________ TRABECULECTOMY INTRA OPERATIVE COMPLICATIONS ________________________________ Conjunctival Flap Related Problems Haemorrhage Scleral Flap Related Problems Choroidal Effusion Stripping of Descemet’s Membrane Vitreous Loss Lens Injury

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ___________________________________________ Hypotony with Shallow / Flat Alc Hypotony with Deep Alc Elevated IOP with Shallow / Flat Alc Elevated IOP with Deep Alc Hyphema Decompression Retinopathy Hypotony Maculopathy Acute Visual Loss Encapsulated Bleb

INTRA OPERATIVE COMPLICATIONS ____________________________________ TRABECULECTOMY INTRA OPERATIVE COMPLICATIONS ____________________________________ 1. Conjunctival Flap Inadequate conjunctiva (Conj. Shrinkage Syndrome) Tears Button holes

INTRA OPERATIVE COMPLICATIONS ________________________________ TRABECULECTOMY INTRA OPERATIVE COMPLICATIONS ________________________________ Haemorrhage Surgical field [ D/c gl. Rx] In the anterior chamber

CONJESTED CONJUNCTIVA

TRABECULECTOMY EARLY POST-OPERATIVE COMPLICATIONS ________________________________ *Hypotony with Shallow Flat Alc *Hypotony with Deep Alc *Elevated IOP with Shallow/Flat Alc *Elevated IOP with Deep Alc *Hyphema *Decompression Retinopathy *Hypotony Maculopathy *Acute Visual Loss *Encapsulated Bleb

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Hypotony with shallow Alc Leaking bleb Over filteration Serous choroidal detachment

Hypotony With Shallow A/C

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Leaks Prevention From the wound From the button hole Management Size of the defect Amount of the leak Observe : 5-7 days (+ patching) other modalities Suturing

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Over Filteration Prevention Management Observation + aqueous suppressants Revision Prolonged hypotony Structural and/or functional changes.

Overfilteration

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Serous Choroidal Detachment Prevention Possible causes Leak Over filteration

EARLY POST OPERATIVE COMPLICATIONS TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Serous Choroidal Detachment (Cont.) Management Observation Indication for drainage Flat Alc [lens corneal touch] Kissing choroidal Prolonged hypotony

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS _____________________________________ 2. Hypotony with Deep Alc Prevention management : Observe for complications ”hypotony maculopathy” Autologuos blood injection Suturing scleral flap Scleral patch grafting

Autologous blood injection

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ 3. Elevated IOP with Shallow/Flat Alc Differential Diagnosis Aqueous misdirection (malignant glaucoma) Pupillary block Suprachoroidal haemorrhage

PUPILLARY BLOCK

HEMORRHAGIC CHOROIDAL

AMD

HEMORRHAGIC CHOROIDAL

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ 4. Elevated IOP with Deep Alc Obstruction of the fistula By blood and/or Fibrin Iris, ciliary processes lens or vitreous Management: Increase topical steroids Tissue plasminogen activator (tPA) topical/intracameral [bleeding] Gonioscopy

IOP with deep A/C

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS _____________________________________ 4. Elevated IOP with Deep Alc (Cont.) Tight scleral flap sutures Ocular massage Suture Lysis Failing bleb Increase topical steroids Subconjuntival antimetabolite Needling the bleb

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Decompression Retinopathy Gradual decompression of the globe.

Decompression Retinopathy

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Acute Visual Loss “wipe out phenomenon” End stage glaucoma Splitted fixation ? It’s existence

TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS ______________________________________ Hyphema

Suprachoroidal Hemorrhage