How are the possible complications of trabeculectomy classified?

Answer

The complications of trabeculectomy can be classified into intraoperative, early postoperative, and late postoperative.

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Media Gallery

Photograph showing an eye after trabeculectomy. The peripheral iridectomy is ideal in its shape, size, and location.
Corkscrew vessels in a bleb 1 week after trabeculectomy.
A conjunctival bleb a few days after trabeculectomy. The bleb is of an ideal height and is diffusely elevated. Although it has slightly dilated blood vessels, they are not excessively tortuous. The limbal sutures should have been buried or tucked under the conjunctiva.
Flow of aqueous after a trabeculectomy.
The ideal flap size in relation to the sclerostomy. The distance between the flap edge and the sclerostomy edge should be greater than or equal to the width of the sclerostomy.
Diagram showing the ideal extent of internal dissection under the scleral flap and the ideal extent of the flap sides (external).
The paracentesis should be placed at an easily accessible point and should be directed away from the lens as in this example of a right eye.
As the scleral flap dissection approaches the limbus, the blade should be angled more parallel to the corneal curvature (green dashed line arrow) to avoid premature entry or entry into the anterior chamber that is too close to the iris plane (red dashed line arrow).
The peripheral iridectomy should have a broad base that is wider than the sclerostomy.
In a fornix-based flap, after the 2 wing sutures have been placed, a tension line (blue dashed line) may be seen running between the 2 sutures. This is a good indicator that the wound is already watertight. This is also a good reference point for the placement of the limbal mattress sutures.
Left eye 2 weeks after surgery. A releasable suture at the superonasal corner of the scleral flap is visible beneath the conjunctiva. The releasable suture at the superotemporal corner had been removed previously. There is a releasable suture (blue) at the superonasal corner of the scleral flap. The flap is outlined in green. The simple interrupted scleral flap sutures and conjunctival anchoring sutures are in black.
Left eye immediately after removal of a releasable suture. The flap outline and the simple interrupted flap sutures are no longer visible due to the increased bleb elevation.
At the anterior limit of the scleral flap the blade is redirected parallel to or towards the iris (green dashed line arrows, left). The "sclerostomy" is actually corneal tissue anterior to the trabecular meshwork/Schlemm canal (right).
A commonly used releasable suture technique.

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