Published in UAB Insight, Spring 2008
Safe and Effective Treatment for Open-Angle Glaucoma
Glaucoma is the second leading cause of blindness worldwide, according to the World Health Organization. Open-angle glaucoma, the most common form of the disease, accounts for 19% of blindness in blacks and 6% in whites. Patients who do not achieve adequate lowering of intraocular pressure with medical therapy require surgery to halt disease progression and preserve vision.
Using the novel Trabectome system, surgeons now can perform ab interno trabeculectomy, a minimally invasive internal filtering procedure for open-angle glaucoma.
The Trabectome is a Food and Drug Administration-approved system that includes a hand-held instrument and a mobile console providing infusion, aspiration, and electrosurgical energy. The instrument, developed by NeoMedix Corporation of Tustin, California, allows surgeons to reduce intraocular pressure without shunts or mechanical implants.
“Most surgeries for glaucoma are designed to lower intraocular pressure by improving drainage of excess aqueous humor,” says ophthalmologist Christopher A. Girkin, MD. “Unlike higher risk external filtering procedures, such as those that utilize tube shunt devices, this new technique uses the specialized Trabectome instrument to remove debris, a small segment of the trabecular meshwork, and the inner wall of Schlemm’s canal, thus reestablishing access to the eye’s natural drainage system. Specifically, the procedure enhances outflow of aqueous from the anterior chamber through increased access to Schlemm’s canal,” he says.
Benefits
The Trabectome procedure does not require external filtration of fluid, lowering the risk of ocular infection and excessively low intraocular pressure, Girkin says.
“In some patients the Trabectome allows us to delay or prevent higher risk procedures, and many patients who undergo ab interno trabeculectomy can decrease their need for intraocular pressure medications, which can be expensive and difficult to tolerate,” he says. In addition, the Trabectome technique spares the conjunctiva and does not preclude subsequent standard filtration operations if they become necessary.
Clinical outcomes from a 30-month follow-up study of patients undergoing the Trabectome procedure compared with other internal trabeculectomy procedures or external trabeculotomy indicated the new system achieves equivalent or better short-term intraocular pressure with fewer serious or vision-threatening complications (Trans Am Ophthalmol Soc. 2006;104:40-50). In appropriately selected patients the procedure lowers intraocular pressure 30% to 40%.
Traditional trabeculectomy, although more effective than the Trabectome at long-term lowering of intraocular pressure, has a higher incidence of wound leaks, infection, chronic inflammation, scarring, vision loss, and development of dangerously low eye pressure.
People with open-angle glaucoma who have good angle structure, no corneal opacities, and in whom the trabecular meshwork is visible are candidates for the Trabectome procedure. Surgeons perform the outpatient procedure in approximately 10 minutes. Patients return for follow-up the next day and 1 week after the procedure.
For more information:
Dr. Christopher Girkin
1.800.UAB.MIST
mist@uabmc.edu