Objective:

David Fleischman, MD, MS, shares lessons on trabeculectomy technique, conjunctival healing, wound leaks, and continued surgical learning.

Approach:

• Limbal technique: Fleischman describes a UNC trabeculectomy technique that intentionally positions Tenon’s capsule against the sclera to encourage a posterior, diffuse bleb.
• Ongoing learning: He advises surgeons to keep developing their techniques and to use mentors, videos, and written resources, including when preparing for surgery.
• Procedure selection: He supports multiple glaucoma procedures, including MIGS and tubes, while describing trabeculectomy as an important option for patients with advanced, severe glaucoma.

Key Findings:

• Fleischman said tissue that is cut scars most aggressively and that controlling Tenon’s position may help shape bleb location.
• In his short-term experience, the described technique was not leak-free: wound leaks occurred less often than with his fornix-based technique but more often than with his limbus-based trabeculectomy.
• He stated that trabeculectomy remains among the best procedures for certain patients with advanced, severe glaucoma, citing evidence and most studies.

Interpretation:

The interview presents trabeculectomy as a procedure requiring deliberate tissue management, postoperative skill, and continued learning, with surgery selected to match the patient.

Limitations:

• The technique’s outcome comparison is described only as Fleischman’s short-term experience; no sample size, numerical leak rates, or study details are provided.
• The transcript refers to a video for a fuller explanation of the surgical technique.

Sources:

• Provided interview transcript