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D. S. Minckler, B. A. Francis, S. Mosaed, L. Dustin; Surgical Outcomes After Trabectome (Trabeculectomy-Internal Approach) for Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2008;49(13):4176.
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To update outcomes from Trabectome for open-angle glaucomas.
The Trabectome permits trabeculectomy via an internal approach through a 1.6mm temporal clear corneal incision. The device includes a ceramic coated pointed footplate inserted under gonioscopic control into Schlemm's canal. An electro-cutting/ablation unit internal to the footplate removes a strip of angle tissues along a 90 - 120 degree arc exposing collector channel openings on the back wall of Schlemm's canal. Continual aspiration of debris and infusion are foot pedal activated simultaneously with ablation. The footplate acts as a guide within Schlemm's, providing anatomic precision as well as thermal and mechanical protection of adjacent structures.
This report includes data from 473 Trabectome®-only eyes, including seventeen pediatric cases and 214 combined Trabectome®-phacoemulsification operations. Among Trabectome®-only eyes, the mean preoperative IOP was 25.3 mmHg and the mean % decrease in IOP 35% at two-years to 16.5 mmHg (n = 30). Complications included reflux bleeding from Schlemm's and collector channels in 73% clearing over a few days but no prolonged hypotony, choroidal effusion, choroidal hemorrhage or infections. IOP spikes postoperatively have been minimal if viscoelastic is thoroughly removed before suturing. Clinical failure led to trabeculectomy in 7% (n = 33) and shunt installation in 1.5% (n = 7). Adjunctive medication use decreased in Trabectome®-only cases from a mean preoperative number of 2.9 to 0.93 by 24 months. Cumulative survival of Trabectome®-only eyes was 65% at 48 months (n = 13) [two weeks or more follow-up or repeat surgery, IOP reduction ≥ 30% or reduction in medications or IOP < 21]. Among combined phaco-Trabectome® eyes the mean base-line IOP was 19.6 mmHg and the mean decrease at 12 months was 24% to 14.9 mmHg (n = 10). Adjunctive medications decreased by 29% from a preoperative mean of 2.2 to a one-year mean of 1.55 (n = 24). Cumulative survival (same definition) among combined cases was 96% at 18 months.
Trabectome surgery alone or combined with cataract extraction offers a minimally invasive effective method of improving IOP control in open-angle glaucomas, Pressure reductions have exceeded those expected after laser trabeculoplasty and complications have been far fewer than expected after trabeculectomy.
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