Intraoperative Complications

Chamber angle bleeding with small hyphema occurs in two-thirds of eyes during trabeculoto-my and in a quarter of eyes undergoing primary trabeculectomy. The blood is usually absorbed during the 1st postoperative day. A frequent intraoperative complication (>5%) of trabeculo-tomy is early perforation of the anterior chamber by the trabeculotomy probe. Further, relatively rare, instrumentally induced intraoperative complications of trabeculotomy are cyclodialysis with postoperative hypotony, iris damage, and lens subluxation [31]. Although trabeculectomy is widely performed by many

7.5 Surgical Complications 107

ophthalmic surgeons, this procedure remains technically challenging in congenital glaucoma, as the limbal anatomy is usually distorted and the sclera extraordinarily thin. This can lead to inadvertent scleral perforation during preparation of the scleral flap. Another potential risk can be prolapse of the vitreous or ciliary body through the peripheral iridectomy into the tra-beculectomy opening, especially in the case of a primarily dislocated lens. Typical intraoperative problems of goniotomy may be touching of the lens, with subsequent cataract formation and leaking corneal incisions. Intraoperative complications of cyclodialysis ab-interno also include massive hemorrhage.

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