J Korean Ophthalmol Soc.  2011 Apr;52(4):502-506.

Ab Interno Trabeculotomy with Trabectome(R) for Refractory Primary Open-Angle Glaucoma: A Case Report

• Chung H
• Choi J
• Choi JY
• Kim YD

Abstract

PURPOSE
To report a case of ab interno trabeculotomy with Trabectome(R) (NeoMedix Corp., CA, USA) conducted on a refractory primary open angle glaucoma (POAG) patient.
CASE SUMMARY
Trabectome(R) has microelectrocautery with simultaneous infusion and aspiration of debris and ablates a segment of trabecular meshwork and the inner wall of Schlemm's canal. The patient, a 54-year-old man had uncontrolled intraocular pressure (IOP) with topical anti-glaucoma medications after trabeculectomy and Ahmed valve implantation for POAG. For the patient, ab interno trabeculotomy with Trabectome(R) was performed. There were no other postoperative complications except for microhyphema immediately after surgery. The IOP was controlled between 14 to 24 mm Hg up to 3 months postoperatively with topical anti-glaucoma medications (Cosopt(R), Alphagan-P(R), Lumigan(R)).
CONCLUSIONS
Ab interno trabeculotomy with Trabectome(R) appears to offer a newer method of lowering IOP in POAG than conventional trabeculectomy and glaucoma drainage device surgery.

Keyword

Ab interno trabeculoctomy; Trabectome

MeSH Terms

Drainage
Glaucoma
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Middle Aged
Postoperative Complications
Trabecular Meshwork
Trabeculectomy

Figure

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  Figure 1. Trabectome surgical steps. (A) Create a 1.6-mm clear corneal incision. (B) Inject a small amount of viscoelastic at the incision site. (C) Place Goniolens on the cornea and verify the angle view. (D) Ablate the trabecular meshwork for approximately in counter-clockwise direction. (E) Rotate the tip. (F) Re-insert the tip in the clockwise direction and remove a similar arc. (G) Irrigate and aspirate viscoelastics from the anterior segment. (H) Place one suture across the incision. Arrow: direction of Trabectome® tip.

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  Figure 2. Gonioscopic findings of the patient at 3 months after surgery. Posterior wall of Schlemm’s canal is visible in the area where the trabecular meshwork is removed by Trabectome®. Long arrow, ablation range of the trabecular meshwork; small arrow, white shimmering of the posterior wall of Schlemm’s canal.

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  Figure 3. Follow-up of the patient’s intraocular pressure changes for 3 months postoperatively.

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  Figure 4. Trabectome handpiece design. (A) Irrigation port for a stable anterior chamber. (B) Aspiration port for removal of ablated tissue. (C) Protective footplate for protection from heat injury to adjacent tissue.5

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  Figure 5. Removal of angle tissue barrier reestablishing natural outflow of aqueous humor. (A) Trabecular meshwork. (B) Schlemm’s canal. (C) Electro-surgical pulse ablation. (D) Irrigation 4

Reference

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