Video Presentation - VT7

From Revision to Innovation: On Table Surgical Strategy in Advanced Glaucoma.

Management of refractory glaucoma following failed conventional procedures remains a significant surgical challenge. This video presents a stepwise approach to a case with unsuccessful trabeculectomy and prior cyclodestructive intervention, emphasizing real-time intraoperative decision-making. Initial revision with bleb needling was attempted to restore filtration; however, due to inadequate response, an on-table transition to minimally invasive glaucoma surgery (MIGS) was undertaken. The procedure demonstrates key technical steps, adaptability, and the rationale behind shifting strategies mid-surgery to achieve effective intraocular pressure control. This case highlights an innovative “revision-to-innovation” paradigm, where intraoperative flexibility enables tailored surgical solutions in advanced glaucoma.