What if IOP rises again after trabeculectomy? needling, digital massage, complication, re-operation

👁 What if IOP rises again after trabeculectomy?

Although trabeculectomy usually controls IOP well in early stages,
bleb fibrosis or adhesion may cause IOP elevation later.
➡ Post-op management becomes crucial.

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💧 1. Digital Massage

• Indicated if IOP > 12 mmHg in early phase
• Gently press the lower eyelid with the index finger for 10 seconds
• Stimulates aqueous flow through bleb
• Alternate: CTM (Carlo Traverso Maneuver)
  • Uses a cotton swab to press over the scleral flap at slit lamp

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🪡 2. Needle Revision (NR)

• Uses a 26G needle to physically break adhesions under the conjunctiva
• Expands the bleb space and restores outflow
• Often combined with 5-FU injections to suppress fibrosis

✅ High-risk cases: 1–2 injections per day starting day 1–2
✅ Low-risk: every 2–3 days as needed

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✅ Summary

• Surgery is not the end — it may require ongoing management
• Digital massage & needle revision can restore failed blebs
• Persistent high IOP → resume drops or consider repeat glaucoma surgery