Abstract
Purpose: :
The Trabectome (NeoMedix, Inc., Tustin, CA) is a novel surgical device used to perform ab interno trabeculotomy. An electrosurgical bipolar instrument is used to unroof Schlemm's canal and expose aqueous collector channels. The purpose of this study is to utilize Fourier-Domain high resolution anterior segment optical coherence tomography (AS-OCT) to evaluate the iridocorneal angle in patients with a cyclodialysis cleft after Trabectome glaucoma surgery.
Methods: :
All Trabectome glaucoma surgeries performed at the Bascom Palmer Eye Institute were reviewed. AS-OCT, in addition to a full ophthalmic examination with gonioscopy, was performed in four patients noted to have a cyclodialysis cleft after Trabectome glaucoma surgery. All cases were performed in conjunction with phacoemulsification cataract surgery. Gonioscopy and AS-OCT imaging were reviewed to evaluate the cyclodialysis cleft and the area of unroofed Schlemm's canal. Subsequent examinations followed the postoperative course of all patients.
Results: :
One study patient had a period of relative hypotony with a cyclodialysis cleft after Trabectome glaucoma surgery and underwent limited argon laser cyclopexy. All patients had partial or full closure of the cyclodialysis cleft in the postoperative period with no significant long-term sequelae. AS-OCT imaging showed cyclodialysis clefts adjacent to areas of treated trabecular meshwork tissue. The cyclodialysis clefts in two patients were noted to be fully closed on both gonioscopy and AS-OCT. Two patients with closure of the cyclodialysis cleft on gonioscopy still had areas of persistent cyclodialysis noted on AS-OCT.
Conclusions: :
Trabectome glaucoma surgery is a novel treatment option for a subset of patients with open angle glaucoma. Prior studies note that complications include intraoperative blood reflux from Schlemm's canal (78.4%) with resulting hyphema or microhyphema, and postoperative elevation in intraocular pressure over 10 mm Hg on the first day after surgery (8.6%). No published reports have described cyclodialysis with Trabectome glaucoma surgery. There are no known studies utilizing any AS-OCT imaging to evaluate the postoperative angle or any associated cyclodialysis clefts. High resolution AS-OCT in this study revealed variably sized areas of persistent cyclodialysis despite apparent resolution on gonioscopy. The high resolution anterior segment imaging and postoperative course of these patients can guide surgeons encountering this rare event with Trabectome glaucoma surgery. Laser cyclopexy or observation are reasonable treatment options.
Keywords: outflow: ciliary muscle • imaging/image analysis: clinical • outflow: trabecular meshwork