NOA Midwestern Symposium 2025: Knowing when to refer when post-trabeculectomy complications arise

Related to a presentation on hypotony-related complications post-trabeculectomy that she gave at the National Optometric Association Midwestern Symposium earlier this month, Dana Shannon, OD, FAAO, focused on critical follow-up care and monitoring for patients who have undergone trabeculectomy, a surgical procedure for glaucoma treatment. She emphasized several key aspects of post-surgical patient management, including immediate post-op monitoring and patient education and engagement.

For post-op monitoring, the primary concern is detecting potential complications early. One critical diagnostic technique involves using a sodium fluorescein strip to check for aqueous leakage. If leakage is detected, immediate referral is necessary to prevent serious complications like endophthalmitis or excessive eye pressure issues. The presence of aqueous leakage indicates a potential breach in the eye's structural integrity that could lead to significant medical risks.

Key signs that require immediate attention include aqueous leakage, developing choroidal effusions, and potential retinal complications.

For patient education and engagement, Shannon noted that many patients mistakenly believe that surgery "cures" their condition, which can lead to poor follow-up compliance. Healthcare providers should explain the ongoing nature of glaucoma, discuss potential sight-threatening complications, assess patient comprehension through interactive questioning, and help patients understand why consistent follow-up is crucial, according to Shannon.

Shannon shared that she also takes a proactive approach to patient follow-up, including personally tracking patient appointments, actively calling patients who miss scheduled check-ups, creating a team-based approach to patient recall, and recognizing that patients have complex lives and may inadvertently miss appointments.

The overarching message is that successful glaucoma management extends far beyond the surgical procedure itself. It requires continuous patient education, vigilant monitoring, and a collaborative approach between healthcare providers and patients to prevent vision loss and manage the chronic nature of the condition.