Is Newer Necessarily Better? The Evolution of Incisional Glaucoma Surgery Over the Last 100 Years

PURPOSE: To examine the progress made in glaucoma incisional surgery and determine if there has been sufficient progress to meet the needs of glaucoma patients. DESIGN: Perspective (literature review). METHODS: This is a retrospective assessment of key milestones in the evolution of glaucoma incisional surgery and an evaluation of the risks and the benefits of these procedures. Benefits are defined as effective reduction in intraocular pressure (IOP) and protecting visual function, while risks are defined as safety and complications for our patients. Quality of life is also considered. RESULTS: Although advances have been made in the last 100 years, the trabeculectomy, a procedure that was described more than 50 years ago, remains the optimal choice for reducing IOP among those patients who require pressures in the teens, who do not respond to medications and prior laser therapy. CONCLUSIONS: Appropriate patient selection, careful attention to surgical technique, and intensive follow-up of patients will optimize the results of a trabeculectomy. Newer procedures must be carefully studied in well designed clinical trials to determine comparative levels of safety and efficacy to this gold standard. Advances in drug delivery and minimally invasive glaucoma surgery may ultimately produce the best outcome for glaucoma patients in the future. (C) 2018 Elsevier Inc. All rights reserved.)