Perspectives in trabecular surgery.

The aim of trabecular surgery is to selectively combat the diseased structure central to the pathogenesis of chronic open-angle glaucoma, thereby reducing potential hazards during and after conventional filtering procedures. This overview considers new techniques in ab interno trabecular surgery. Special emphasis is placed on the description of each novel technique, its instrumentation, presumed mechanism of action and clinical results. Trabecular aspiration is evaluated as a method of clearing intertrabecular spaces of extracellular debris in pseudoexfoliation glaucoma with or without simultaneous cataract surgery or goniocurettage, while laser trabecular ablation is discussed for the treatment of absolute glaucomas. Where corneal haze has formed visualisation of the anterior chamber angle structures and trabecular surgery is performed with the aid of a microendoscope. Although the results are very promising it should be understood that some of these procedures are still in the experimental phase and are undergoing careful clinical evaluation, leaving plenty of room for refinements and further developments.