EnVision Summit 2025: Complications in glaucoma surgery

The EnVision conference featured several presentations on the complications of glaucoma surgery. Tania Tai, the vice chair of clinical operations and director of the glaucoma clinic and wet lab at the New York Eye and Ear Infirmary of Mount Sinai, discussed the issue of tube occlusions, a rare but known complication of glaucoma drainage implant surgery.

Tai highlighted a case where the tube was occluded by vitreous, which she explained is best managed by performing a pars plana vitrectomy. She emphasized the importance of first removing the vitreous plug from the tube to ensure there is no residual occlusion before amputating the vitreous. Tai also mentioned other causes of tube occlusions that may not require surgical intervention.

Shivani Kamat, a glaucoma specialist at UT Southwestern in Dallas, presented on the topic of cyclodialysis clefts in the setting of minimally invasive glaucoma surgery (MIGS). Kamat noted that as MIGS procedures have become increasingly popular, these types of complications have become more common. She stressed the importance of knowing the ocular anatomy well when performing MIGS, recommending that surgeons practice goniotomy in the clinic and get comfortable with the setup and instrumentation before operating. Kamat also suggested using trypan blue dye to better visualize the trabecular meshwork and avoid inadvertently treating the ciliary body, which could lead to a cleft.

Lucy Shen, the director of the glaucoma fellowship at Mass Eye and Ear, discussed the surgical management of an overhanging bleb, a complication that can occur after trabeculectomy. Shen explained that the overhanging portion of the bleb that has invaded the cornea must be removed, and the bleb itself must be revised to redirect the flow of aqueous humor posteriorly. She emphasized the importance for glaucoma specialists to be familiar with both minimally invasive glaucoma procedures as well as traditional surgeries like trabeculectomy, as patients with complications from prior operations may still present for care.

Both Shen and Tai expressed excitement about the potential of new sustained-release and implantable/injectable glaucoma medications. They believe these emerging therapies could improve medication efficacy, reduce ocular surface side effects, and address issues with patient compliance, ultimately leading to better outcomes for glaucoma patients.