Surgical Trabeculectomy

The slit lamp exam and tonometry are the two tests of concern following a surgical tra-beculectomy. Conjunctival injection may be mild to marked (1+ to 3+). There may be a subconjunctival hemorrhage. The conjunctival drainage bleb will usually be large and at least slightly elevated. The suture line is usually superior under the upper cul de sac, so it may be difficult to

Figure 7-6. Filtration bleb. (Photo by Val Sanders.)

Figure 7-6. Filtration bleb. (Photo by Val Sanders.)

visualize (have the patient look way down). There may be mild corneal edema and/or folds (1+). There is generally a marked anterior chamber reaction of 2+ to 3+. You should also note the chamber depth. Immediately after surgery, it is normal for the chamber to be shallow. Note if a hyphema is present as well as the pupil size and shape. If the trabeculectomy was combined with cataract surgery, see also the section on cataracts.

As the eye heals, continue to monitor the bleb. It should be elevated and blisterlike (Figure 7-6). If not, be sure to note that it is flat. Sometimes a bleb becomes lumpy, cystic, or encapsulated in appearance. Be sure to note if the bleb begins to encroach onto the cornea. Be on the alert for dellen. Watch the AC for depth and inflammation as well as for formation of anterior or posterior synechia. Check the lens for formation of a cataract.

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