ABSTRACT
Generically speaking, the ultimate goal of glaucoma therapy is to maintain the quality of vision of the affected patient. Glaucoma filtration surgery can be followed by sightthreatening complications. Postoperative management of the trabeculectomy patient can sometimes be more difficult than the procedure itself.The adoption of releasable sutures and the availability of viscoelastics have made flat anterior chamber and delayed postoperative suprachoroidal haemorrhage less common.12 However, the extensive use of potent antimetabolites led to a dramatic increase in chronic hypotony, late bleb leaks and late endophthalmitis.13,14 Furthermore, a commonly voiced concern about trabeculectomy surgery is the risk of late postoperative cataract development. The Collaborative Normal Tension Glaucoma Study showed that cataract developed in 26% of the treatment group (of which 16% occurred in operated eyes), compared with 11% of the non-treated group.15 A 78% increased risk of developing a cataract was reported by the investigators of the AGIS, the risk, not surprisingly, being higher in the case of postoperative complications.16The development of a clinically relevant cataract is not irrelevant to the ultimate success rate of a filtration procedure. In fact, a planned cataract extraction in a previously filtered eye may be paralleled by malfunction of the filtration bleb.12
