Modification of trabeculectomy to avoid postoperative hyphaema. The 'guarded anterior fistula' operation.

The effect of varying the position of a trabeculectomy fistula on the rate of postoperative hyphaema was studied in a prospective randomised trial. One eye of each of 78 consecutive patients with primary open angle glaucoma and exfoliation glaucoma was allocated to one of two groups. In group A the fistula was fashioned anterior to the scleral spur, entirely in corneal tissue. In group B the fistula included cornea and sclera with trabecular meshwork and scleral spur. Seven out of 39 eyes (18%) in group A developed a postoperative hyphaema with detectable blood level, compared with 22 out of 39 eyes (56%) for group B (p less than 0.001). In addition, the severity of the bleeding was greater in group B, and the three cases of recurrent bleeding were all in this group. Group B patients remained in hospital for an average of 3.9 days, which was significantly longer (p = 0.004) than the average of 2.9 days for group A. This difference was related to the frequency and severity of the hyphaema. The type of dissection or the occurrence of hyphaema did not influence the intraocular pressure at 4 months after surgery.