Indications for trabeculectomy in open angle glaucoma.

Trabeculectomy is the most commonly performed filtering procedure in the surgical treatment of open angle glaucoma. One may oversimplify and state that a trabeculectomy is indicated in a case of uncontrolled IOP on maximum tolerated medical therapy in the presence of significant optic disk and/or visual field changes. However, before one actually proposes a trabeculectomy one must consider for a given patient: How does one define IOP control? What are the chances of success of the surgery? What are the operative risks? What are the risks of not operating for the case under consideration? And more generally: What are the arguments of earlier surgery? Where does Argon Laser Trabeculoplasty fit into the therapeutic regimen? The questions are examined with the specific goal of making a rational decision for the patient at hand.