Post-operative management of trabeculectomy in the first three months

A successful trabeculectomy is a stable surgical fistula. The one thing required to keep a fistula patent (open) is flow. The principal and most challenging complication is scarring; however, other complications may occur, as outlined in this article. Prevention is vastly preferable to cure, so take every precaution you can to avoid complications. This involves careful case selection and, before surgery, optimisation of the operating environment. In addition, patients should have been counselled prior to surgery so their expectations match their post-operative experience. Nevertheless, every surgeon – even with the most meticulous attention to correct surgical approach and technique – will at some stage encounter most of the complications mentioned here. Active interventions to avoid complications are therefore common, occurring in about half of post-operative patients at some stage. Please note, if you have to go back to theatre with someone within four weeks of surgery, I would recommend a low threshold to general anaesthesia if at all possible. The eye is already infl amed from the fi rst operation (and the complications). This can make the fi eld more tricky; local anaesthetic does not work so well since it is rapidly washed away even with the use of adrenaline. In addition, the patient is all the more anxious due to the need for repeat surgery (as are you). General anaesthesia offers a much better environment for both patient and surgeon. In addition, the operation is much faster; a ‘quick extra suture’ can be less than quick under local anaesthesia.