How Glaucoma Surgery Prevents Vision Loss

After surgery for glaucoma initially the bleb is raised showing good flow of aqueous. As time passes the scarring sets in and flow is reduced. The bleb height decrease and vascularization sets in. Here is the tricky part what should we do to optimise the flow of aqueous. In this particular bleb , we reduced the frequency of steroid drops intentionally to allow a controlled degree of scarring, helping the IOP recover to a safer range.

Looking back at the course so far, the priority has remained the same: keeping the fistula functioning and maintaining adequate aqueous drainage. The challenge is that aqueous humor contains prostaglandins and inflammatory mediators that can increase vascularity and promote fibrosis, both of which threaten long-term bleb survival and may eventually close the fistula.

To counter this process, the current plan is to reduce bleb vascularity through targeted steroid therapy in and around the bleb lake. Triamcinolone vs Betamethasone which drug to choose. Our experience with both of the drugs we find Betamethasone is safer option due to its short life and better tissue obsorption.

Triamcinolone on the other hand will be obsorbed late due to its crystaline nature and will cause local side effects like bleb thinning ultimately leading to bleb leakage.