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

2. 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

3. 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

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

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

6. CONJESTED CONJUNCTIVA

8. 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

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

10. Hypotony With Shallow A/C

11. 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

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

14. Overfilteration

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

17. 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

19. 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

20. Autologous blood injection

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

22. PUPILLARY BLOCK

23. HEMORRHAGIC CHOROIDAL

24. AMD

25. HEMORRHAGIC CHOROIDAL

26. 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

27. IOP with deep A/C

28. 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

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

30. Decompression Retinopathy

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

32. TRABECULECTOMY EARLY POST OPERATIVE COMPLICATIONS
______________________________________
Hyphema

33. Suprachoroidal Hemorrhage