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January 2004

The Case Against Glaucoma Drainage Implant Surgery in Patients Witha Poor Prognosis for Standard Filtering Procedure

Author Affiliations

From the Department of Ophthalmology, University of Maryland Schoolof Medicine, Baltimore.

 

NEIL M.BRESSLERMD

Arch Ophthalmol. 2004;122(1):105-107. doi:10.1001/archopht.122.1.105

Ever since MacKenzie in the 1830s first suggested filtration surgeryas a strategy for combating glaucomatous progression,1 clinicianshave remained determined to improve the technique in an effort to maximizesuccess and reduce complications. As a profession we have been largely successful,considering the introduction of the guarded trabeculectomy by Sugar2 in 1961 and the subsequent enhancement of the procedurewith antifibrotic agents such as fluorouracil and mitomycin C.3 Althoughmany would argue that the latter modification is a mixed blessing, most wouldagree that with proper patient selection, meticulous surgical technique, andcareful follow-up, the benefits of antifibrotic-enhanced filtration surgeryoutweigh the risks. Therefore, given the current state of the art of trabeculectomy,the only obvious first choice for eyes that either have demonstrated progressionor may be at high risk for progression is without a doubt the trabeculectomy.In fact, most patients who are being considered for surgical interventiondeserve at least one attempt at suc-ceeding with a trabeculectomy, preferablywith adjunctive use of an antifibrotic agent. In this discussion, an argumentin favor of trabeculectomy and reasons why a glaucoma filtration device (GFD)should not be the first choice will be presented.

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