End Stage Glaucoma

Glaucoma is the second leading cause of blindness in the general population. The definition of end-stage glaucoma may be based on a very constricted visual field, or a markedly severed visual acuity (Gillies& Brooks et al., 2000). Many factors have been postulated to put the patient at a high risk. Achieving an individually fashioned target IOP is supposed to minimize the risk of glaucoma progression (Nouri-Mahdavi & Hoffman et al., 2004). Medical regimens may induce significant short and long term IOP fluctuations. Surgery should be considered in end stage glaucoma. Trabeculectomy has been reported to be associated with less diurnal IOP fluctuation compared to maximum medical therapy. Wipe-out phenomenon is a rare complication and may be considered as a blast from the past. Meanwhile, Trabeculectomy has many surgical difficulties. Emphasis on guidelines for a successful trabeculectomy without toil is presented, besides the new modalities to achieve a favorable outcome.