Consider focal pressure in case of poor filtration shortly after trabeculectomy

Achieving a good filtration in the early postoperative period after trabeculectomy is associated with the procedure's long-term success (1). Shortly after surgery, the scleral flap could be sticky, oedematous and tight sutures may momentarily hamper aqueous filtration through the sclerostomy preventing the bleb's formation. A practical and effective method to encourage filtration is to apply focal pressure directly to the conjunctiva, beside the scleral flap's edge and not over the flap, until the development of a conjunctival filtration bleb and fall of pressure are obtained (2,3).

Initially described using an anaesthetic-moistened cotton-tip applicator, this manoeuvre can also be performed by gently pressing with the rubber plunger of an insulin syringe, under topical anaesthesia and povidone iodine instillation. Focal pressure can be repeated multiple times in the first postoperative days until spontaneous filtration is deemed adequate or sufficient time is elapsed to safely perform suture lysis.

Contributor: Carlo A. Cutolo - Clinica Oculistica, University of Genoa and San Martino Polyclinic Hospital - Italy

References

1. Okimoto S, Kiuchi Y, Akita T, Tanaka J. Using the early postoperative intraocular pressure to predict pressure control after a trabeculectomy. J Glaucoma. 2014 Aug;23(6):410-4.
2. Traverso CE, Greenidge KC, Spaeth GL, Wilson RP. Focal pressure: a new method to encourage filtration after trabeculectomy. Ophthalmic Surg. 1984 Jan;15(1):62-5.
3. Spaeth GL, Katz J, Myers J, Pecora LJ, Fellman RL. (2013). Chapter 15 - Glaucoma Surgery – Carlo Traverso Maneuver. In Duane TD, Tasman W;Jaeger EA (Eds.), Duane's Ophthalmology (2013 edition). Lippincott Williams & Wilkins.

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