NOV 14, 2012
In this guest editorial, the authors contemplate the future of trabeculectomy in the face of new procedures used in combined glaucoma and cataract surgery. They conclude that while trabeculectomy may remain the most commonly performed standalone glaucoma filtration procedure, it will likely be replaced by one or more novel methods of lowering IOP used adjunctively with cataract surgery.
"The majority of patients being treated with IOP-lowering therapy who have cataract surgery do not receive adjunctive trabeculectomy as the risk versus benefit for this glaucoma procedure does not make sense in patients with mild to moderate disease risk," they write. "This is precisely the group of individuals for whom the glaucoma revolution is unfolding."
A myriad of glaucoma procedures, including trabecular meshwork shunts and suprachoroidal shunts, are being studied as potentially safer alternatives to trabeculectomy when combined with cataract surgery.
For busy cataract surgeons who also have a substantial numbers of patients with controlled glaucoma, the authors write, these advances will undoubtedly revolutionize their practices over the next decade. For the more traditional glaucoma specialists who spend most of their time taking care of patients with advanced and/or uncontrolled disease, these novel glaucoma procedures will have a smaller impact on practice patterns.