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Abstract #5848 Published in IGR 2-1
A call for innovative operations for glaucoma (editorial comment)
Katz LJArchives of Ophthalmology 2000; 118: 412-413
In this editorial, the author discusses some aspects of present filtering surgery for glaucoma. In fact, the editorial deals with the problems of bleb-leaks and endophthalmitis. He states that there are numerous early and late bleb-related problems. He also states that filtering surgery has been performed for more than 100 years with minor modifications. We enjoy only rudimentary control over long-term bleb integrity and function. The author asks a number of questions: 1. What is the worst possible outcome of a leaking bleb? The outcome is blindness. He states that progression to endophthalmitis occurs in some 56%. Whenever an endophthalmitis develops the prognosis may be ominous. 2. What predisposes blebs to leak after surgery? Answer: thin blebs (this was known from full-thickness filtering procedures). Use of antimetabolites causes more thinner avascular blebs that are more prone to leak. He states that we have improved IOP control with antimetabolites at the expense of increasing the risk of bleb infections. 3. How are leaking blebs best managed? Answer: Surgical revision. The most reliable method is with a free or sliding conjunctival graft. However, this may lead to loss of bleb function and diplopia. 4. Why is there ambivalence toward performing filtration surgery? Answer: unclear definitions of therapeutic success. He mentions the confusing polarization between supporters of 'early' glaucoma surgery and more conservative voices expressing caution against overtreatment for a slowly progressive disease. He sites the well-known studies from the UK and feels that they have omitted from their analysis the late bleb leaks and endophthalmitis. Our main goal is to preserve quality of life, i.e., preservation of functional vision the chance of remaining function seen in the light of life expectancy of the patient has to be carefully considered. 5. What is the ideal glaucoma operation? Answer: one leading to a thick-walled bleb or better no bleb at all with good pressure control. At the moment this does not exist. Even the new non-penetrating operations do not have enough data that they will be the new operation of the future.
Classification:
12.1 General management, indication (Part of: 12 Surgical treatment)
