الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
SUMMARY
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SUMMARY AND CONCLUSION
Subscleral trabeculectomy has been subjected through the
years to numerous modifications regarding, the type of conjunctival
flap, the shape ofthe scleral flap, the type of suture material.
It has been a definite tendency over the past few years to
minimize usage of suture material up to advocating sutureless
surgery and this is applicable to cataract and glaucoma surgery.
These trends have been supported by the evident greater
wound stability, less tendency to postoperative astigmatic shift and
hence faster post operative physical and visual rehabilitation.
The present study was conducted to evaluate the potential
advantages and disadvantages, success rate, and complications of
this procedure for glacuoma surgery by Lerner (1997), which
includes the formation of a filtration fistula without any dissection
of the Tenon’s capsule, through a small incision, as an alternative to
trabeculectomy with or without pharmacologic wound modulation.
The study was carried out on sixty eyes of fifty patient
undergoing a small incision trabeculectomy avoiding Tenon’s
capsule. (microtrabeculectomy) using Kelley Desement membrane
punch.
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Complete success in the study was defined as an lOP less than
or equal to 20 mmHg without any therapy, whereas, qualified
success was defined as an lOP not exceeding 20 mmHg with topical
antiglaucoma medications, follow up of the studied eyes to the sixth
post operative month revealed that 91% of cases were able to stop
their anti-glaucoma medications completely, 3% of cases were
controlled with topical therapy, and 6% showed failure and needed
resurgery.
This new technique is a low cost and safe alternative to
conventional trabeculectomy that effectively reduces intraocular
pressure. The use of a small 2.5 mm incision which obviates the
dissection of the Tenon’s capsule and subsequent subconjunctival
fibrosis, the absence of requirement of any sophisticated
instruments, and the absence of any major complications which are
encountered with the use of anti-metabolites entails that this
procedure be performed more often in glaucomatous eyes needing
filtration surgery. Also, Microtrabeculectomy in eyes with high risk
of scarring was found efficacious and relatively safe. The relatively
small peritomy, the tunnel approach, and the avoidance of radial
incisions seen to offer important advantages over the standard
trabeculectomy.
The current procedure also entails several technical
advantages. A sclerocorneal pocket, rather than a scleral flap,
eliminates the need to grasp a scleral flap and pull it anteriorly
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during the anterior incision of the trabeculectomy block, as IS
generally done in a standard trabeculectomy. This manipulation is
occassionally risky, especially for a thin, friable scleral flap.
Furthermore, the small sugical area, adjacent to the limbus,
eliminates the need for a bridle suture. Furthermore, the operation
time is considerably shorter than that of the standard procedure.
Also, being a very small incision, leaving other areas
untouched in case additional intraocular surgeries are required.
Cautery is used minimally or not used at all, avoiding other
stimulus for post operative scarring.
Although longer follow up is necessary. These results are
encouraging. This procedure, which is performed with nonsophisticated
instruments, may provide some advantages over
conventional trabeculectomy.