Glaucoma filtering surgery: rational algorithm of patients’ follow-up

Purpose of the study: to present a rational algorithm of post-operative visits of patients who have undergone trabeculectomy (TE). Material and methods. In a prospective interventional single-center open cohort study participated 1,100 sequentially enrolled patients operated by three surgeons (the authors of the study) in 2022–2024 in the City Multidisciplinary Hospital No. 2 regarding the non-compensated primary open-angle glaucoma and then observed in the clinic for 3–6 months. The frequency and optimal timing of post-operative examination, providing timely diagnosis and adequate treatment of TE complications, the main ones being shallow anterior chamber (AC) due to hyperfiltration in the first 2 weeks as well as excessive scarring later after surgery is analyzed. Results. The date of the next visit was determined during the first examination of the operated patient 2 to 3 hours after the TE. The unchanged depth of the AC, combined with the diffuse filtration bleb (FB), allowed for outpatient treatment with follow-up in the hospital 3 weeks after TE, at the beginning of the FB remodulation phase, and then 2–4 times during the 2nd month after the surgery. Slightly reduced due to overfiltration depth of the AC allowed outpatient treatment, but required checkups at the clinic 3, 7 and 14 days after TE (until normalization of anatomical relationships in the anterior segment) and then 2–4 times during the second month after the surgery. Flat AC, recorded a few hours after TE, was the reason for the prolongation of the stationary treatment, at least 2–3 days for its therapeutic and surgical recovery. The follow-up examinations were carried out on the 7th and 14th day after TE and then 2–4 times during the second month after the surgery. Lack of aqueous flow from under the scleral flap in the first hours after surgery did not prevent patient discharge but involved a set of recovery and maintenance filtration measures during checkups after 3, 7 and 14 days after TE and then weekly for the second month following the surgery. Conclusion. Unlike uncomplicated phacoemulsification of senile cataracts, where the adequacy of a one-time visit to the local clinic is not in doubt, the success of conjunctival glaucoma surgery is not possible without a close 2-month follow-up by the glaucoma surgeon, which involves 5 to 7 check-ups. In the uncomplicated early postoperative period, special attention should be given to the patient on the 4th–8th week after TE while in hyperfiltration or lack of FB the main therapeutic activities occur in the first 2 weeks after the surgery.

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