Anterior Chamber Blood Reflux During Trabeculectomy in an Eye With Previous Trabectome Surgery

INTRODUCTIONThe Trabectome is a novel surgical device used in the treatment of open angle glaucoma that removes trabecular meshwork tissue to improve aqueous access to drainage channels. Little is known about the long-term consequences of permanently unroofing Schlemm canal. Eyes that have had previous surgery in the iridocorneal angle, specifically permanent removal of trabecular meshwork tissue, may have an increased propensity for blood reflux. CASE PRESENTATIONWe present a case of a patient who had intraoperative blood reflux onto peripheral iris during trabeculectomy 11 months after Trabectome surgery. DISCUSSIONIntraoperative blood reflux and resultant hyphema is strongly correlated with Trabectome surgery, but the literature does not reveal any cases of late postoperative blood reflux. In our patient, the absence of overlying angle structures, including the roof of Schlemm canal, may have allowed blood to reflux into the angle and onto peripheral iris during a sudden decrease in intraocular pressure in trabeculectomy surgery. Further studies to assess the consequences of permanent trabecular meshwork tissue removal may be warranted.