Trabectome

A trabectome is a surgical device that can be used for Ab interno trabeculotomy, a minimally invasive glaucoma surgery for the surgical management of adult, juvenile and infantile glaucoma. Trabecular meshwork is the main site of resistance for aqueous outflow. Hence most glaucoma surgeries work by either removing the trabecular meshwork or bypassing that. As angle surgeries such as Trabectome follow physiologic outflow pathway, the risk of complications are significantly lower than filtering surgeries. The Trabectome handpiece is inserted into the anterior chamber and positioned into the Schlemm's canal. Bent tip of it's footplate fits into the canal and smoothly advanced parallel to the angle. The energy delivered by electrode cause plasma mediated trabeculat meshwork ablation without damaging nearby structures. Active irrigation of trabectome surgery system helps to keep anterior chamber formed during the procedure and precludes the need for ophthalmic viscoelastic device. Viscoelastics tend to trap produced debris or gas bubbles and diminish visualization.By ablating trabecular meshwork, aqueous get access to Schlemm's canal , therefore reducing intraocular pressure which is major risk factor for glaucomatous vision loss. The irrigation/aspiration device provides irrigation during surgery and collection of residual fluid and ablated tissue in a collection bag. This procedure is performed through a small incision and can be done on an outpatient basis.[1]

This device was invented by George Baerveldt at the University of California, Irvine and has been manufactured by the NeoMedix Corporation in Tustin, California.

The images below illustrate how it improves aqueous drainage by removing the damaged trabecular meshwork.

Trabectome decreases intra-ocular pressure to mid-teen range and reduces patient's requirement to take glaucoma eye drops and glaucoma medications (see references).

Currently, there are no published studies that compare outcomes for efficacy and safety of Trabectome to other procedures for treating glaucoma.[2]

References

  1. ↑ http://www.glaucoma.org/treatment/the-future-of-glaucoma-surgery.php
  2. ↑ Hu K, Gazzard G, Bunce C, Wormald R (2016). "Ab interno trabecular bypass surgery with Trabectome for open angle glaucoma". Cochrane Database Syst Rev. 8: CD011693. doi:10.1002/14651858.CD011693.pub2. PMID 27526051.


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