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D. S. Minckler, Trabectome Study Group, B. A. Francis, S. Mosaed, M. Ramirez, Trabectome Study Group; Update on Clinical Outcomes After Trabectome Surgery for Open-Angle Glaucoma. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5673.
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To update clinical outcomes from Trabectome surgery for open-angle glaucomas including POAG (n = 172); pseudoexfoliation (n = 18); JRA (n = 2); myopic degeneration (n = 5); pigmentary (n = 2); steroid-induced (n = 2).
The Trabectome is a new instrument that facilitates ab interno trabeculotomy via a temporal clear corneal incision. The device tip includes a ceramic coated pointed footplate inserted under gonioscopic control (modified Swan-Jacobs goniolens) into Schlemm's canal. An electro-cutting/ablation function created across a gap between active and return electrodes internal to the footplate removes a strip of inner wall of Schlemm's and the meshwork as the instrument tip is advanced along a 30 - 90 degree arc of the angle. Continual aspiration of debris and infusion of balanced salt are foot pedal activated simultaneously with ablation of angle tissues. The footplate acts as a glide within Schlemm's, providing anatomic precision as well as thermal and mechanical protection of adjacent structures.
To date (10/15/06) 201 Trabectome procedures have been performed, all except two in adults with open-angle glaucoma, including 41 combined with phacoemulsification. The mean overall preoperative IOP was 25.2 + 7.4 mmHg and the mean overall postoperative IOP at 36 months (n = 5) was 17.0 + 4.1 mmHg (42% decrease). At 12 months (n = 43), the mean IOP was 16.7 + 2.6 mmHg (47% decrease). Complications have included back-bleeding from Schlemm's in 100% clearing over a few days but no vision-threatening occurrences otherwise such as prolonged hypotony, or choroidal effusion or hemorrhage. IOP spikes postoperatively have been minimal if viscoelastic, when used, is carefully removed before suturing the 1.6 mm clear corneal wound. Clinical failure led to subsequent trabeculectomy in 9 eyes and shunt installation in 3 eyes.
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. Importantly this procedure does not preclude subsequent standard filtering surgery as the conjunctiva is unharmed. Surgical skills-transfer has been easy among the several surgeons who have used the device to date.
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