What is a Trabectome Glaucoma Procedure?
The Trabectome is a FDA approved device used for the surgical treatment of treatment of open angle glaucoma during cataract surgery in a minimal invasive fashion.
What is Glaucoma?
Glaucoma is a multifactorial disease in which in most cases the intraocular pressure is elevated. Aqueous humor (fluid) is continually produced inside the eye and is drained from the eye from the through the trabecular meshwork into Schlemm’s canal into the blood stream. The trabecular meshwork is a cheese-cloth like structure overlying Schlemm’s canal that drains the fluid out of the eye located around the inside portion of the eye where the sclera (white portion of the eye) meets the cornea (clear portion of the eye). This elevation causes damage to the optic nerve in back of the eye which transmits the vision to the vision center in the back portion of the brain. The intraocular pressure is elevated due to the trabecular meshwork becoming partially clogged or blocked by material collecting in the meshwork.
How does the Trabectome Work?
The Trabectome safely ablates and removes a 60 degree to 120 degree strip of trabecular meshwork which improves the fluid flow into the drainage system and away from the eye. The Trabectome is used in glaucoma patients who are having cataract surgery due to blurred vision.
The Trabectome Procedure
A 1.7mm incision is made in the cornea adjacent to the sclera. A contact lens like goniolens is placed on the eye that allows the surgeon to visualize the angle where the trabecular meshwork is located. The Trabectome is then inserted inside the eye and the trabecular meshwork is ablated for approximately 4 clock hours around the eye. After the Trabectome procedure is completed, the normal cataract surgery procedure is performed through the same incision in the eye.
Other Glaucoma Procedures
Trabeculectomy and tube shunts have been the standard surgical procedures for treating glaucoma that are not under adequate control with medications or SLT laser treatment. These procedures involve external filtration or drainage of the aqueous humor from inside the eye onto the surface of the sclera underneath the conjunctiva (outer layer of tissue over the sclera containing the blood vessels on the eye). The aqueous humor is then absorbed from the conjunctival tissue. These procedures carry risk of complications such as hypotony (too low of an eye pressure), choroidal effusion (fluid collecting in the layer under the retina), hemorrhage, scarring of the conjunctiva leading to failure of the procedure, endophthalmitis.
Results of Trabectome Surgery Compared to Trabeculectomy Surgery for Glaucoma
The intraocular pressure lowering of patients with this surgery has been in the range of a 25% to 30% at one year with minimal complications.
The intraocular pressure lowering effect of patients with this surgery has been in the range 40% to 50% at one year with a higher incidence of complications.
The Trabectome offers a minimally invasive glaucoma procedure that is combined with cataract surgery. It lowers the eye pressure by a significant percent with few complications. The more traditional procedures such as trabeculectomy and aqueous shunts lower eye pressures to a lower number but have a much higher complication rate. The Trabectome offers another procedure that the eye surgeon has available to them in treating glaucoma.