LATE-ONSET BLEB leaks, commonly seen after glaucoma filtration surgery, have been clearly associated with an increased risk of developing an infected bleb.1 This fact, among others, has prompted a serious, fundamental reconsideration of our surgical approach and philosophy regarding the management of patients with glaucoma. There are numerous early and late bleb-related problems requiring attention.2 In contrast to a whirlwind of advances in cataract and refractive surgery, filtering surgery remains a relatively primitive operation for diverting aqueous into the subconjunctival space. It has been performed for more than 100 years with minor modifications: conversion to guarded filtration, incorporation of antimetabolites, and postoperative flap suture release (either laser suture lysis or the cutting of externalized sutures). Determinants of bleb morphology and continual structural evolution remain poorly understood. Correspondingly, we enjoy only rudimentary control over long-term bleb integrity and function. Soltau et al1 have reminded us of the persistent risks accompanying the benefits achieved with filtering operations. This should lead to a series of questions which, when answered, may challenge our current treatment strategy for glaucoma.
Katz LJ. A Call for Innovative Operations for Glaucoma. Arch Ophthalmol. 2000;118(3):412–413. doi:10.1001/archopht.118.3.412
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