Eyeworld

SEPTEMBER 2021 | EYEWORLD | 79 G About the physicians Leon Herndon Jr., MD Duke University Durham, North Carolina Douglas Rhee, MD Professor and Chair Department of Ophthalmology and Visual Sciences Case Western Reserve University Cleveland, Ohio References 1. Sugar HS. Experimental trab- eculectomy in glaucoma. Am J Ophthalmol. 1961;51:623–627. 2. Cairns JE. Trabeculectomy: Preliminary report of a new method. Am J Ophthalmol. 1968;66:673–679. 3. Heuer DK, et al. 5-fluorouracil and glaucoma filtering surgery. II. A pilot study. Ophthalmology. 1984;91:384–394. 4. Chen CW, et al. Trabeculec- tomy with simultaneous topical application of mitomycin-C in refractory glaucoma. J Ocul Pharmacol. 1990;6:175–182. 5. Kitazawa Y, et al. Trabe- culectomy with mitomycin. A comparative study with fluorouracil. Arch Ophthalmol. 1991;109:1693–1698. by Ellen Stodola Editorial Co-Director T hough the trabeculectomy procedure is more than 50 years old, it is still considered to be the gold standard in glaucoma surgery. Even with new devices and techniques, particularly many microinvasive options, trabeculectomy is able to produce the best pressure-lowering effect. Leon Herndon Jr., MD, and Douglas Rhee, MD, discussed the history of trabeculectomy, how it has evolved, and how it fits into the glau- coma treatment paradigm. Dr. Herndon said he thinks trabeculectomy is still the gold standard of glaucoma surgery. "If you need a low pressure, there's nothing that comes close to the lowering effect of trabeculec- tomy," he said. According to Dr. Rhee, the procedure is at- tributed to H. Saul Sugar, MD. Though he noted that the concept of having an open hole in the eye to drain fluid has been around since 1830, Dr. Sugar wrote about a progenitor of modern trabeculectomy in 1961, 1 and J.E. Cairns, FRCS, later published on the method and reported on a guarded filtration procedure in 1968. 2 Dr. Cairns popularized trabeculectomy, Dr. Herndon said. Before this, there were full thickness procedures, essentially making a hole in the eye with no cover. "Dr. Cairns decided to make a guarded trabeculectomy where you create a flap instead of just making the punch," he said. "At the time there were so many compli- cations with full thickness procedures, cataract formation, hypotony, etc., the guarded filtration procedures became more popular because of the greater safety profile." Evolution in technique Dr. Herndon and Dr. Rhee agreed that though there has been some slight adjustments to the technique, there hasn't been much evolution in the procedure as it was initially presented. The main evolution, Dr. Herndon said, has been with antimetabolites and different techniques of applying mitomycin-C. He also mentioned how the technique has evolved for conjunctival dissection from limbal-based to Examining trabeculectomy continued on page 80 Dr. Herndon performs a trab EX-PRESS Glaucoma Filtration Device procedure. Source (all): Leon Herndon, MD

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