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Article | 2026 AAO Glaucoma Subspecialty Day

Surgical Pearls for Improving Trabeculectomy Outcomes

David Fleischman, MD, MS, reviews techniques for managing conjunctival healing and wound leaks while emphasizing continued surgical learning.

By: Shivani S. Kamat, MD, Mary Qiu, MD,
Glaucoma Physician October 22, 2026

Clinical Scorecard: Surgical Pearls for Improving Trabeculectomy Outcomes

At a Glance

CategoryDetail
ConditionClinical topic addressed by the source article: Surgical Pearls for Improving Trabeculectomy Outcomes
Key MechanismsThe speaker describes controlling where Tenon’s capsule lies against the sclera to support a posterior diffuse bleb; wound leaks occurred in short-term data.
Target PopulationPatients with advanced severe glaucoma, for whom the speaker says trabeculectomy is among the best procedures by evidence and most studies.
Care SettingGlaucoma surgery and surgical training.

Key Highlights

  • The speaker describes a limbal technique used at UNC that intentionally controls where Tenon's capsule lies against the sclera.
  • In the speaker’s short-term data, wound leaks occurred less often than with a fornix-based technique but more often than with a limbus-based trabeculectomy technique.
  • The speaker states that trabeculectomy remains one of the best procedures for some patients with advanced severe glaucoma, citing evidence and most studies.
  • The discussion emphasizes continued surgical learning, including seeking mentorship and using videos and publications.
  • The speakers support teaching trabeculectomy alongside other glaucoma procedures, including MIGS and tube surgery.

Guideline-Based Recommendations

Diagnosis

    Management

    • The speaker describes intentionally controlling where Tenon’s capsule lies against the sclera as part of the UNC limbal technique.
    • The speaker says trabeculectomy is an important option for patients with really advanced severe glaucoma and emphasizes matching the patient to the surgery.

    Monitoring & Follow-up

      Risks

        Patient & Prescribing Data

        Patients with glaucoma considered for surgery; the speaker particularly identifies patients with advanced severe glaucoma as candidates for whom trabeculectomy may be appropriate.

        The article provides no medication prescribing data. It discusses surgical selection and technique, and notes that trabeculectomy, MIGS, and tube surgery are among the available glaucoma procedures.

        Clinical Best Practices

        • Continue learning and developing surgical skills throughout one’s career, as the speaker advises.
        • The speaker recommends reaching out to mentors and using videos and publications to learn, including before surgery.
        • The speaker reports that wound leaks occurred in short-term data with the described technique.

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