Management
Trabeculectomy doesn’t end in the operating room. In many ways, that’s where the real work begins.
A posterior, low-lying diffuse bleb remains a key target, as emphasized by BPOS, for long-term success in glaucoma surgery. The goal is to maintain function while carefully titrating intraocular pressure (IOP).
In the early phase,
consider reducing steroids to every two hours, then taper further if IOP trends too low. A whiter bleb is often a favorable sign, indicating less vascularity and a more stable outcome over time.
Close monitoring is essential.
Review the patient
every 12–14 days to assess bleb morphology, IOP, and healing response. If IOP begins to rise, suture release can be timed around 4–5 weeks, extending up to 6–8 weeks if needed.
Steroid adjustments should remain dynamic.
Increase or reduce based on the degree of scarring and vascular activity observed. The balance is delicate: enough control to prevent fibrosis, but not so much that hypotony becomes a risk.
This structured, responsive approach helps guide decision-making and supports better long-term bleb performance.
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