On a recent CataractCoach Podcast (the top podcast in all of ophthalmology), I was surprised when an ophthalmologist from outside the USA knew that there are certain states where patients cannot get a trabeculectomy performed and they must travel to a neighboring state. Trabeculectomy is more than 100 years old and it has stood the test of time because it is a procedure that works and all anterior segment surgeons must know how to perform it. I routinely taught residents how to perform a trabeculectomy (or combined phaco-trab) over the course of more than 20 years. You must learn this technique and this video will show the way.
Trabeculectomy with releasable sutures is a widely used technique in glaucoma surgery that offers greater postoperative control of aqueous outflow and intraocular pressure (IOP). During the procedure, sutures that secure the scleral flap are tied in a manner that allows selective removal in the postoperative period, typically at the slit lamp under topical anesthesia. This approach enables surgeons to titrate filtration based on the patient’s IOP response and bleb morphology, minimizing the risk of hypotony or bleb failure. Releasable sutures are especially useful in eyes at higher risk for scarring, such as those of younger patients or those with prior surgery. By allowing for gradual and controlled reduction in resistance to aqueous outflow, this technique reduces the need for more invasive postoperative interventions like needling. Proper suture placement and timing of release are critical for optimal outcomes, and the method has become a standard adjunct in modern trabeculectomy.
