Glaucoma Surgical Management: Is a Chance to Cut Finally a Chance to Cure?

In the 2011 American Glaucoma Society Subspecialty Day Lecture, Dr. Dale Heuer describes the historic bias toward medical treatment for glaucoma that may be misplaced in certain patient situations. Major and incremental improvements in trabeculectomy warrant consideration of the surgery earlier in the treatment paradigm. Laser trabeculoplasty and possibly endocyclophotocoagulation are options in patients with mild to moderate glaucoma. The Tube Versus Trabeculectomy (TVT) study validates aqueous shunts as a reasonable alternative to trabeculectomy with MMC in patients who have undergone previous surgery. Finally, novel and minimally invasive approaches that improve or bypass the trabecular meshwork may sufficiently improve outflow and lower IOP.