Surgical management of glaucoma: a review

This review will briefly describe the history of surgical glaucoma treatment and concentrate on the current surgical strategies for managing glaucoma. A discussion of treatments for angle closure, open-angle glaucoma and paediatric glaucoma with an emphasis on drainage surgery are included. The role of cataract surgery is also briefly described. Drainage surgery evolved from peripheral iridectomy and sclerotomy with an increasing understanding of aqueous flow within the eye and the production of a functioning bleb. The current mainstays include trabeculectomy, glaucoma drainage devices as well as goniotomy and trabeculotomy, which have all been in existence for more than 40 years. Their various advantages as well as methods used to minimize their disadvantages, including the antimitotics and case selection are discussed. We finish by discussing the preliminary results of some newer forms of drainage surgery illustrating the energetic search for methods to minimize the problems of hypotony and bleb failure.