Purpose: To review two cases of open angle glaucoma(OAG) refractory to medical and surgical treatment that underwent a novel surgical technique. Methods: Case reports of a novel surgical technique which consists in a trabeculectomy with Mitomycin C and aqueous diversion to the suprachoroidal space. Results: The target intraocular pressure remains stable after surgery without using any medical treatment. No severe complications were observed during follow-up. Conclusion: Managing intraocular pressure in refractory glaucoma has always been a challenge, and the need of both surgical and medical approaches is common. This novel surgical technique has the advantage of using 2 filtering pathways, which allows an adequate aqueous humor drainage even if one of the pathways fails.

We report the occurrence and management of a massive serous detachment of the macula, which followed trabeculectomy and lowering of the intraocular pressure (IOP) in a patient with central retinal vein occlusion (CRVO) and a previously undiagnosed complex coagulopathy with elevated plasma fibrinogen and homocysteine levels, as well as prothrombin 20210 and factor V Leiden mutations. Our case illustrates prompt resolution of the serous detachment with elevation of the IOP, and acute recurrence of the detachment following subsequent recurrence of hypotony after aqueous tube shunt surgery. Residual cystoid macular edema (CME) in the right eye, as well as hemiretinal vein occlusion with serous macular detachment and CME in the fellow left eye responded to bevacizumab. The occurrence of severe macular edema following lowering of intraocular pressure may warrant further evaluation for possible underlying venous occlusive disease or systemic coagulopathy.

PURPOSE To summarize the original literature on ab interno trabeculectomy with the Trabectome system and to review its efficacy and safety in the treatment of glaucoma. METHOD A literature search in PubMed was performed on ab interno trabeculectomy with the Trabectome system, and clinical relevant information was reviewed and summarized. RESULTS Ab interno trabeculectomy with the Trabectome system on average lowered intraocular pressure (IOP) to the mid-teens, and decreased the number of required glaucoma medications. Greater preoperative IOP correlated to a greater percent reduction in IOP. The success rates varied among studies, and the definition of success differed by authors. Intraoperative blood reflux was found in nearly all cases. Incidences of early hypotony and IOP spikes were low. No cases of endophthalmitis, wound leak, aqueous misdirection, choroidal hemorrhage or effusions, and irreversible visual acuity decrease (≥2 Snellen lines) have been reported. Available studies had a significant amount of data overlap. Only limited data on long-term results was available. There was no randomized controlled trial to date. CONCLUSIONS Ab interno trabeculectomy with the Trabectome system is an effective and safe surgical approach for patients with various types of open angle glaucoma. On average, the procedure at least in the short term lowers IOP to the mid teens regardless of preoperative IOP with or without the aid of topical medications.

Purpose: To report the results of a Latin American (LA) consensus panel regarding the diagnosis and management of primary open angle glaucoma, and to compare these results with those from a similar panel in the United States (US). Design: A RAND-like appropriateness methodology was used to assess glaucoma practice in LA. Methods: The 148 polling statements created for the RAND- like analysis in the US and 10 additional statements specific to glaucoma care in LA were presented to a panel of LA glaucoma experts. Panelists were polled in private using the RAND- like methodology prior to and after a panel meeting. Results: Consensus agreement or disagreement amongst LA experts was reached for 51.3% of statements prior to the meeting and increased to 66.5% in the private, anonymous post meeting polling (79.0% agreement, 21.0% disagreement). While there was a high degree of concordance (111 of 148 statements, 75%) between the results of this LA panel and the US panel, there were some notable exceptions relating to diagnostic and therapeutic decision-making. Conclusions: This RAND-like consensus methodology provides a perspective of how LA glaucoma practitioners view many aspects of glaucoma and compares these results with those obtained using a similar methodology from practitioners in the US. These findings may be helpful to ophthalmologists providing glaucoma care in LA and in other regions of the world.