Trabeculectomy has remained essentially unchanged since it was first described by Cairns in 1968. However, bugbears such as sub-conjunctival fibrosis and failure as well as flap-related problems such as uneven flap; maceration/tears in the flap; irritation, foreign body reaction and rarely, abscess secondary to flap sutures; sealing of the triplanar flap etc, are problems associated with it.
One thing Harminder S Dua MD, PhD does now that he didn't in years past is delay surgery for limbal deficiency in patients who retain a central island of corneal epithelium and reasonable vision.
While Descemet's membrane endothelial keratoplasty (DMEK) is a technically more difficult procedure, it provides better visual results with fewer problems than Descemet's stripping endothelial keratoplasty (DSEK)
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