While cataract surgery alone helps to lower intra-ocular pressure in glaucoma patients (in fact, in all patients), it is sometimes not sufficient to achieve the target IOP. Removing the 4+ mm thick cataract with a 1 mm (or thinner) IOL allows the angle of the eye to deepen significantly. The patient in this case needs a target pressure of less than 10 mmHg in order to slow progression of vision loss due to glaucoma. Our guest surgeon performs a combination of cataract surgery plus a trabeculectomy in order to achieve that. The trabeculectomy surgery has many variations, however the basic concepts have been in place for many decades. There are variations of where the conjunctiva is opened (limbal based versus fornix based), how the scleral flap is created (I prefer making a scleral tunnel with a crescent blade and then using Vannas scissors to cut the sides), use and placement of mitomycin-C, and even the method for suturing. Any cataract surgeon can learn to perform a beautiful, safe, and effective trabeculectomy.
click to learn from this nicely performed trabeculectomy surgery: