For a study, researchers sought to understand that trabeculectomy surgery was associated with complications such as leakage, over filtration, and surgical bleb fibrosis. The morphology of the surgical bleb was a significant predictor of surgical success, which is defined as long-term IOP reduction with few to no complications. Many, often subtle, changes have been made to the surgical technique to improve long-term IOP reduction. Fewer changes, however, had been implemented specifically to modify bleb morphology. Investigators’ surgical practice started with a thorough dissection and advancement of Tenon’s layer with incorporation into a 2-layered conjunctival closure. The technique allowed the aqueous flow to a defined potential space between the sclera and Tenon’s layer. Compared to a more traditional trabeculectomy technique, their clinical observations revealed improved bleb morphology characterized by diffuse, low-lying blebs with nonischemic overlying conjunctiva. They had a small number of patients in their practice who had a more traditional trabeculectomy technique in the fellow eye because they implemented the change at a specific time. As a result, a few patients had trabeculectomy in 1 eye in their surgical practice before implementing the new technique. They then had trabeculectomy in the other eye after the technique was implemented, allowing them to compare bleb morphology with and without Tenon advancement. The study group presented 2 representative index cases and described the surgical technique in the series.
