From the Research
A unilateral trabeculectomy ab-externo (intracapsular) is indicated for patients with glaucoma who have failed to achieve adequate intraocular pressure control with medication and laser treatments, or who have progressive visual field loss or optic nerve damage despite maximum tolerated medical therapy. This procedure is a surgical intervention that aims to reduce intraocular pressure by creating an alternative drainage pathway for aqueous humor. The surgery involves creating a small flap in the sclera, removing a portion of the trabecular meshwork, and establishing a filtering bleb under the conjunctiva to allow fluid to drain from the anterior chamber of the eye 1.
The term "unilateral" indicates that the procedure is performed on only one eye, while "ab-externo" means the approach is from outside the eye. "Intracapsular" refers to the technique of maintaining the integrity of the lens capsule during the procedure. Patients typically require postoperative care including topical antibiotics, steroids, and sometimes anti-fibrotic agents to prevent scarring of the newly created drainage pathway. Regular follow-up appointments are essential to monitor intraocular pressure and assess the function of the filtering bleb.
Some key points to consider when evaluating the indication for unilateral trabeculectomy ab-externo (intracapsular) include:
- The patient's response to pre-surgical administration of prostaglandin analogs, as certain medications such as bimatoprost may be associated with a higher risk of recurrent IOP elevation after trabeculectomy 2
- The presence of deepening of the upper eyelid sulcus (DUES), which may be associated with a higher risk of recurrent IOP elevation after trabeculectomy 2
- The potential benefits and risks of the procedure, including the risk of complications such as hypotony maculopathy and endophthalmitis, which may be lower with alternative procedures such as ab-interno trabeculotomy-related glaucoma surgeries 1
Overall, the decision to perform a unilateral trabeculectomy ab-externo (intracapsular) should be based on a careful evaluation of the patient's individual needs and circumstances, taking into account the potential benefits and risks of the procedure.