Intraoperative Complications of Trabeculectomy

Trabeculectomy is performed to achieve lower intraocular pressure by creating a surgical fistula to increase aqueous outflow into a conjunctival bleb. In spite of a well-performed procedure, the final outcome is unpredictable due to variable and unknown factors in wound healing leading to bleb failure. The margin of error in performing trabeculectomy is very small. Every effort should be made to avoid intraoperative complications. The surgeon should learn and modify his or her techniques to strive for perfection. However, if intraoperative complications occur, one should be able to recognize them and take appropriate action at the time of surgery. Some of the important precautions during surgery are: Avoid subconjunctival hemorrhage by using a corneal traction suture instead of a superior rectus traction suture. Handle conjunctiva carefully by using nontoothed forceps or Weck-cel sponge for dissection. Keep it moist to avoid shrinkage. Obtain good hemostasis by using pencil-tip cautery in the deep scleral bed and on the scleral surface but away from the scleral flap margin. Always look for buttonholes and wound leaks. The anterior chamber should be maintained with balanced salt solution and not a viscoelastic at the conclusion of the surgery.