Skip to main content
SpringerLink
Log in

Complications of Glaucoma Surgery

  • Chapter
  • First Online:
Clinical Glaucoma Care

  • 1789 Accesses

Abstract

This chapter will review the management of complications of glaucoma surgery, specifically of guarded filtration procedures (trabeculectomy). Overall, severe visual loss is uncommon, but the incidence of transient complications (e.g., early postoperative hypotony, mild hyphema) is relatively high. Some rare complications can be very severe, such as suprachoroidal hemorrhage and endophthalmitis, potentially leading to permanent visual loss.

The frequency, risk factors, management, and strategies to prevent complications will be discussed, including hypotony and overfiltration, choroidal effusions, hypotony maculopathy, suprachoroidal hemorrhage, hyphema, malignant glaucoma, wipeout, early and late bleb leak, early and late failure of filtering bleb, bleb encapsulation, symptomatic bleb, cataract, and bleb-related ocular infection. Most adverse events can be prevented with proper surgical technique. Current best practices for each of the complications will be discussed with a pragmatic point of view.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Jampel HD, Musch DC, Gillespie BW, et al. Perioperative complications of trabeculectomy in the Collaborative Initial Glaucoma Treatment Study (CIGTS). Am J Ophthalmol. 2005;140:16–22.

    Article  PubMed  Google Scholar 

  2. Edmunds B, Thompson JR, Salmon JF, Wormald RP. The national survey of trabeculectomy. III. Early and late complications. Eye. 2002;16:297–303.

    Article  PubMed  CAS  Google Scholar 

  3. Gedde SJ, Herndon LW, Brandt JD, et al. Surgical complications in the tube versus trabeculectomy study during the first year of follow up. Am J Ophthalmol. 2007;143:23–31.

    Article  PubMed  Google Scholar 

  4. Azuara-Blanco A, Katz LJ. Dysfunctional filtering blebs. Surv Ophthalmol. 1998;43:93–126.

    Article  PubMed  CAS  Google Scholar 

  5. Blok MDW, Kok JHC, van Mil C, et al. Use of the megasoft bandage lens for treatment of complications after trabeculectomy. Am J Ophthalmol. 1990;110:264–8.

    PubMed  CAS  Google Scholar 

  6. Simmons RJ, Kimbrough RL. Shell tamponade in filtering surgery for glaucoma. Ophthalmic Surg. 1984;10:17–34.

    Google Scholar 

  7. Fink AJ, Boys-Smith JW, Brear R. Management of large filtering blebs with the argon laser. Am J Ophthalmol. 1986;101:695–9.

    PubMed  CAS  Google Scholar 

  8. Lynch MG, Roesch M, Brown RH. Remodeling filtering blebs with the Neodymium:YAG laser. Ophthalmology. 1986;103:1700–5.

    Article  Google Scholar 

  9. Leen MM, Moster MR, Katz LJ, et al. Management of overfiltering and leaking blebs with autologous blood injection. Arch Ophthalmol. 1995;113:1050–5.

    Article  PubMed  CAS  Google Scholar 

  10. Wise JB. Treatment of chronic postfiltration hypotony by intrableb injection of autologous blood. Arch Ophthalmol. 1993;111:827–30.

    Article  PubMed  CAS  Google Scholar 

  11. Lu DW, Azuara-Blanco A, Katz LJ. Severe visual loss after autologous blood injection for mitomycin-associated hypotony maculopathy. Ophthalmic Surg Lasers. 1997;28:244–5.

    PubMed  CAS  Google Scholar 

  12. Schwartz GF, Robin AL, Wilson RP, et al. Resuturing the scleral flap leads to resolution of hypotony maculopathy. J Glaucoma. 1996;5:246–51.

    PubMed  CAS  Google Scholar 

  13. Haynes WL, Alward WLM. Rapid visual recovery and long-term intraocular pressure control after donor scleral-patch grafting for trabeculectomy-induced hypotony maculopathy. J Glaucoma. 1994;4:200–1.

    Google Scholar 

  14. Suner IJ, Greenfield DS, Miller MP, Nicolela MT, Palmberg PF, Skuta GL. Hypotony maculopathy after filtering surgery with mitomycin-C: incidence and treatment. Ophthalmology. 1997;104:207–15.

    Article  PubMed  CAS  Google Scholar 

  15. Eha J, Hoffmann EM, Wahl J, Pfeiffer N. Flap suture–a simple technique for the revision of hypotony maculopathy following trabeculectomy with mitomycin C. Graefes Arch Clin Exp Ophthalmol. 2008;246:869–74.

    Article  PubMed  CAS  Google Scholar 

  16. Letartre L, Basheikh A, Anctil JL, Des Marchais B, Goyette A, Kasner OP, Lajoie C. Transconjunctival suturing of the scleral flap for overfiltration with hypotony maculopathy after trabeculectomy. Can J Ophthalmol. 2009;44:567–70.

    Article  PubMed  Google Scholar 

  17. Zacharia PT, Deppermann SR, Schuman JS. Ocular hypotony after trabeculectomy with mitomycin C. Am J Ophthalmol. 1993;116:314–26.

    PubMed  CAS  Google Scholar 

  18. Shields MB, Scroggs MW, Sloop CM, Simmons RB. Clinical and histopathologic observations concerning hypotony after trabeculectomy with adjunctive mitomycin C. Am J Ophthalmol. 1993;116:673–83.

    PubMed  CAS  Google Scholar 

  19. Costa VP, Wilson RP, Moster MR, et al. Hypotony maculopathy following the use of topical mitomycin C in glaucoma filtration surgery. Ophthalmic Surg. 1993;24:389–94.

    PubMed  CAS  Google Scholar 

  20. Gedde SJ, Herndon LW, Brandt JD, et al. Postoperative complications in the tube versus trabeculectomy (TVT) study during five years of follow-up. Am J Ophthalmol. 2012;153:804–14.

    Article  PubMed  Google Scholar 

  21. Melamed S, Ashkenazi I, Glovinski J, Blumenthal M. Tight scleral flap trabeculectomy with postoperative laser suture lysis. Am J Ophthalmol. 1990;109:303–9.

    PubMed  CAS  Google Scholar 

  22. Chopra H, Goldenfeld M, Krupin T, Rosenberg LF. Early postoperative titration of bleb function: argon laser suture lysis and removable sutures in trabeculectomy. J Glaucoma. 1992;1:54–7.

    Article  Google Scholar 

  23. Traverso CE, Greenidge KC, Spaeth GL, Wilson RP. Focal pressure: a new method to encourage filtration after trabeculectomy. Ophthalmic Surg. 1984;15:62–5.

    PubMed  CAS  Google Scholar 

  24. Morinelli EN, Sidoti PA, Heuer DK, et al. Laser suture lysis after mitomycin C trabeculectomy. Ophthalmology. 1996;103:306–14.

    Article  PubMed  CAS  Google Scholar 

  25. Pappa KS, Derick RJ, Weber PA, et al. Late argon laser suture lysis after mitomycin C trabeculectomy. Ophthalmology. 1993;100:1268–71.

    Article  PubMed  CAS  Google Scholar 

  26. Wilson RP. Technical advances in filtration surgery. In: McAllister JA, Wilson RP, editors. Glaucoma. Boston: Butterworths; 1986. p. 243–350.

    Google Scholar 

  27. Cohen JS, Osher RH. Releasable scleral flap suture. Ophthalmol Clin North Am. 1988;1:187–97.

    Google Scholar 

  28. Johnstone MA, Wellington DP, Ziel CJ. A releasable scleral-flap tamponade suture for guarded filtration surgery. Arch Ophthalmol. 1993;111:398–403.

    Article  PubMed  CAS  Google Scholar 

  29. Tezel G, Kolker AE, Kass MA, Wax MB. Late removal of releasable sutures after trabeculectomy or combined trabeculectomy with cataract extraction supplemented with antifibrotics. J Glaucoma. 1998;7:75–81.

    Article  PubMed  CAS  Google Scholar 

  30. Cantor LB, Katz LJ, Spaeth GL. Complications of surgery in glaucoma: suprachoroidal expulsive hemorrhage in glaucoma patients undergoing intraocular surgery. Ophthalmology. 1985;92:1266–70.

    Article  PubMed  CAS  Google Scholar 

  31. Ruderman JM, Harbin TS, Campbell DG. Postoperative suprachoroidal hemorrhage following filtering procedures. Arch Ophthalmol. 1986;104:201–5.

    Article  PubMed  CAS  Google Scholar 

  32. Givens K, Shields MB. Suprachoroidal hemorrhage after glaucoma filtering surgery. Am J Ophthalmol. 1987;103:689–94.

    PubMed  CAS  Google Scholar 

  33. Frenkel REP, Shin DH. Prevention and management of delayed suprachoroidal hemorrhage after filtration surgery. Arch Ophthalmol. 1986;104:1459–63.

    Article  PubMed  CAS  Google Scholar 

  34. Jampel HD, Musch DC, Gillespie BW, et al. Perioperative complications of trabeculectomy in the collaborative initial glaucoma treatment study (CIGTS). Am J Ophthalmol. 2005;104:16–22.

    Article  Google Scholar 

  35. AGIS investigators. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. Am J Ophthalmol. 2002;124:481–98.

    Google Scholar 

  36. Quigley HA, Frieadman DS, Congdon NG. Possible mechanisms of primary angle-closure and malignant glaucoma. J Glaucoma. 2003;12:167–80.

    Article  PubMed  Google Scholar 

  37. Epstein DL, Steinert RF, Puliafito CA. Neodymium:YAG laser therapy to the anterior hyaloid in aphakic malignant (ciliary block) glaucoma. Ophthalmology. 1980;87:1155–9.

    Article  Google Scholar 

  38. Lois N, Wong D, Groenwald C. New surgical approach in the management of pseudophakic malignant glaucoma. Ophthalmology. 2001;108:780–3.

    Article  PubMed  CAS  Google Scholar 

  39. Byrnes GA, Leen MM, Wong TP, Benson WE. Vitrectomy for ciliary block (malignant) glaucoma. Ophthalmology. 1995;102:1308–11.

    Article  PubMed  CAS  Google Scholar 

  40. Azuara-Blanco A, Katz LJ, Gandham S, Spaeth GL. Pars plana tube insertion of aqueous shunt with vitrectomy in malignant glaucoma. Arch Ophthalmol. 1988;116:808–10.

    Article  Google Scholar 

  41. Lichter PR, Ravin JG. Risk of sudden visual loss after glaucoma surgery. Am J Ophthalmol. 1974;78:1009–13.

    PubMed  CAS  Google Scholar 

  42. Costa VP, Smith M, Spaeth GL, Gandham S, Markovitz B. Loss of visual acuity after trabeculectomy. Ophthalmology. 1993;100:599–612.

    Article  PubMed  CAS  Google Scholar 

  43. Law SK, Nguyen AM, Coleman AL, Caprioli J. Severe loss of central vision in patients with advanced glaucoma undergoing trabeculectomy. Arch Ophthalmol. 2007;125:1044–50.

    Article  PubMed  Google Scholar 

  44. Moster MR, Moster ML. Wipe-out: a complication of glaucoma surgery or a just a blast from the past. Am J Ophthalmol. 2005;140:705–6.

    Article  PubMed  Google Scholar 

  45. Eke T. Anesthesia for glaucoma surgery. Ophthalmol Clin North Am. 2006;19:245–55.

    PubMed  Google Scholar 

  46. Kumar CM, Dowd TC, Dodds C, Boyce R. Orbital swelling following peribulbar and sub Tenon’s anaesthesia. Eye. 2004;18:418–20.

    Article  PubMed  CAS  Google Scholar 

  47. Hulbert MF, Yang YC, Pennefather PM, Moore JK. Pulsatile ocular blood flow and intraocular pressure during retrobulbar injection of lignocaine: influence of additives. J Glaucoma. 1998;7:413–16.

    Article  PubMed  CAS  Google Scholar 

  48. Huber KK, Remky A. Effect of retrobulbar versus subconjunctival anaesthesia on retrobulbar haemodynamics. Br J Ophthalmol. 2005;89:719–23.

    Article  PubMed  CAS  Google Scholar 

  49. Parrish 2nd EK, Schiffman JC, Feuer WJ, Heuer DK, Fluorouracil Filtering Surgery Study Group. Prognosis and risk factors for early postoperative wound leaks after trabeculectomy with and without 5-Fluorouracil. Am J Ophthalmol. 2001;132:633–40.

    Article  PubMed  CAS  Google Scholar 

  50. Zalta AH, Wieder RH. Closure of leaking filtering blebs with cyanoacrylate tissue adhesive. Br J Ophthalmol. 1991;75:170–3.

    Article  PubMed  CAS  Google Scholar 

  51. Asrani SG, Wilenski JT. Management of bleb leaks after glaucoma filtering surgery. Use of autologous fibrin tissue glue as an alternative. Ophthalmology. 1996;103:294–8.

    Article  PubMed  CAS  Google Scholar 

  52. Kajiwara K. Repair of a leaking bleb with fibrin glue. Am J Ophthalmol. 1990;109:599–601.

    PubMed  CAS  Google Scholar 

  53. Wilensky JT. Management of late bleb leaks following glaucoma filtering surgery. Trans Am Ophthalmol Soc. 1992;93:161–8.

    Google Scholar 

  54. Wadhwani RA, Resham A, Bellows AR, et al. Surgical repair of leaking filtering blebs. Ophthalmology. 2000;107:1681–7.

    Article  PubMed  CAS  Google Scholar 

  55. Burnstein AL, WuDunn D, Knotts L, et al. Conjunctival advancement versus nonincisional treatment for late-onset glaucoma filtering bleb leaks. Ophthalmology. 2002;109:71–5.

    Article  PubMed  Google Scholar 

  56. Catoria Y, Wudunn D, Cantor LB. Revision of dysfunctional filtering blebs by conjunctival advancement with bleb preservation. Am J Ophthalmol. 2000;130:574–9.

    Article  Google Scholar 

  57. Harris L, Yang G, Feldman RN, et al. Autologous conjunctival resurfacing of leaking filtering blebs. Ophthalmology. 2000;107:1675–80.

    Article  PubMed  CAS  Google Scholar 

  58. Maumenee AE. External filtering operations for glaucoma: the mechanism of function and failure. Trans Am Acad Ophthalmol Soc. 1960;58:319–28.

    CAS  Google Scholar 

  59. Starita RJ, Fellman RL, Spaeth GL, et al. Short- and long-term effects of postoperative corticosteroids on trabeculectomy. Ophthalmology. 1985;92:938–46.

    Article  PubMed  CAS  Google Scholar 

  60. Joshi AB, Parrish 2nd RK, Feuer WF. 2002 survey of the American Glaucoma Society: practice preferences for glaucoma surgery and antifibrotic use. J Glaucoma. 2005;14:172–4.

    Article  PubMed  Google Scholar 

  61. Siriwardena D, Edmunds B, Wormald RP, Khaw PT. National survey of antimetabolite use in glaucoma surgery in the United Kingdom. Br J Ophthalmol. 2004;88:873–6.

    Article  PubMed  CAS  Google Scholar 

  62. Goldenfeld M, Krupin T, Ruderman JM, et al. 5-fluorouracil in initial trabeculectomy. A prospective, randomized, multicenter study. Ophthalmology. 1994;101:1024–9.

    Article  PubMed  CAS  Google Scholar 

  63. The Fluorouracil Filtering Surgery Study Group. Five-year follow-up of the Fluorouracil Filtering Surgery Study. Am J Ophthalmol. 1996;121:349–66.

    Google Scholar 

  64. Kitazawa Y, Suemori-Matsushita H, Yamamoto T, Kawase K. Low-dose and high-dose mitomycin trabeculectomy as an initial surgery in primary open-angle glaucoma. Ophthalmology. 1993;100:1624–8.

    Article  PubMed  CAS  Google Scholar 

  65. Wu-Dunn D, Cantor LB, Palanca-Capistrano AM, et al. A prospective randomized trial comparing intraoperative 5-fluorouracil versus mitomycin C in primary trabeculectomy. Am J Ophthalmol. 2002;134:521–8.

    Article  CAS  Google Scholar 

  66. Ewing RH, Stamper RL. Needle revision with and without 5-fluorouracil for the treatment of failed filtering blebs. Am J Ophthalmol. 1990;110:254–9.

    PubMed  CAS  Google Scholar 

  67. Greenfield DS, Miller MP, Suner IJ, et al. Needle revision of failed filtering blebs using mitomycin-C. Ophthalmology. 1996;122:195–204.

    CAS  Google Scholar 

  68. Mardelli PG, Lederer CM, Murrary PL, et al. Slit-lamp needle revision of filtering blebs using mitomycin C. Ophthalmology. 1996;103:1946–55.

    Article  PubMed  CAS  Google Scholar 

  69. Shetty RK, Wartluft L, Moster MR. Slit-lamp needle revision of failed filtering blebs using high-dose mitomycin C. J Glaucoma. 2005;14:52–6.

    Article  PubMed  Google Scholar 

  70. Feldman RM, Gross RL, Spaeth GL, et al. Risk factors for the development of Tenon’s capsule cysts after trabeculectomy. Ophthalmology. 1989;96:336–41.

    Article  PubMed  CAS  Google Scholar 

  71. Scott DR, Quigley HA. Medical management of a high bleb phase after trabeculectomies. Ophthalmology. 1988;95:1169–73.

    Article  PubMed  CAS  Google Scholar 

  72. Azuara-Blanco A, Bond BJ, Wilson RP, Moster MR, Schmidt CM. Encapsulated filtering blebs after trabeculectomy with mitomycin-C. Ophthalmic Surg Lasers. 1997;28:805–9.

    PubMed  CAS  Google Scholar 

  73. Palanca-Capistrano AM, Hall J, Cantor LB, et al. Long-term outcomes of intraoperative 5-fluorouracil versus intraoperative mitomycin C in primary trabeculectomy surgery. Ophthalmology. 2009;116:185–90.

    Article  PubMed  Google Scholar 

  74. Katz LJ, Cantor LB, Spaeth GL. Complications of surgery in glaucoma. Early and late bacterial endophthalmitis following glaucoma filtering surgery. Ophthalmology. 1985;92:959–63.

    Article  PubMed  CAS  Google Scholar 

  75. Caronia RM, Liebmann JM, Friedman R, et al. Trabeculectomy at the inferior limbus. Arch Ophthalmol. 1996;114:387–91.

    Article  PubMed  CAS  Google Scholar 

  76. Greenfield DS, Suner IJ, Miller MP, et al. Endophthalmitis after filtering surgery with mitomycin. Arch Ophthalmol. 1996;114:943–9.

    Article  PubMed  CAS  Google Scholar 

  77. Mandelbaum S, Forster RK, Gelender H, Culbertson W. Late onset endophthalmitis associated with filtering blebs. Ophthalmology. 1985;92:964–72.

    Article  PubMed  CAS  Google Scholar 

  78. DeBry PW, Perkins TW, Heatley G, et al. Incidence of late-onset bleb-related complications following trabeculectomy with mitomycin. Arch Ophthalmol. 2002;120:297–300.

    Article  PubMed  CAS  Google Scholar 

  79. Soltau JB, Rothman RF, Budenz DL, et al. Risk factors for glaucoma filtering bleb infections. Arch Ophthalmol. 2000;118:338–42.

    Article  PubMed  CAS  Google Scholar 

  80. Jampel HD, Quigley HA, Kerrigan-Baumrid LA, The Glaucoma Surgical Outcomes Study Group, et al. Risk factors for late-onset infection following glaucoma filtration surgery. Arch Ophthalmol. 2001;119:1001–8.

    Article  PubMed  CAS  Google Scholar 

  81. Song A, Scott IU, Flynn Jr HW, et al. Delayed-onset bleb-associated endophthalmitis: clinical features and visual acuity outcomes. Ophthalmology. 2002;109:985–91.

    Article  PubMed  Google Scholar 

  82. Kangas TA, Greenfield DS, Flynn Jr HW, et al. Delayed-onset endophthalmitis associated with conjunctival filtering blebs. Ophthalmology. 1997;104:746–52.

    Article  PubMed  CAS  Google Scholar 

  83. Reynolds AC, Skuta GL, Monlux R, et al. Management of blebitis by members of the American Glaucoma Society: a survey. J Glaucoma. 2001;10:340–7.

    Article  PubMed  CAS  Google Scholar 

  84. Wand M, Quintiliani R, Robinson A. Antibiotic prophylaxis in eyes with filtration blebs: survey of glaucoma specialists, microbiological study, and recommendations. J Glaucoma. 1995;4:103–9.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Wills Eye Institute, 100 Presidential Blvd. Suite 200, Bala Cynwyd, PA, 19004, USA

    Marlene R. Moster MD

  2. Centre of Vision and Vascular Science, Queen’s University Belfast, Institute of Clinical Science – Block A, Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, UK

    Augusto Azuara-Blanco PhD, FRCOphth, FRCS(Ed)

Authors
  1. Marlene R. Moster MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Augusto Azuara-Blanco PhD, FRCOphth, FRCS(Ed)
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marlene R. Moster MD .

Editor information

Editors and Affiliations

  1. Rocky Visa University, Littleton, Colorado, USA

    John R. Samples

  2. Visual Health Center, Palm Springs, Florida, USA

    Paul N. Schacknow

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer Science+Business Media New York

About this chapter

Cite this chapter

Moster, M.R., Azuara-Blanco, A. (2014). Complications of Glaucoma Surgery. In: Samples, J., Schacknow, P. (eds) Clinical Glaucoma Care. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4172-4_29

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-4172-4_29

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-4171-7

  • Online ISBN: 978-1-4614-4172-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation