Electrocautery device helps improve OAG management

Lynda Charters

Fort Lauderdale, FL-The Trabectome procedure (NeoMedix Corp.) with its low complication rate and high success rate suggests that it might be a promising primary surgical intervention for improved surgical management of patients with open-angle glaucoma (OAG), according to Sameh Mosaed, MD, at the annual meeting of the Association for Research in Vision and Ophthalmology here.

"The Trabectome is a novel surgical device created to treat adult and juvenile glaucoma," said Dr. Mosaed, assistant professor of ophthalmology, department of ophthalmology, University of California, Irvine, CA. "This device allows for ablation of a segment of the trabecular meshwork and inner wall of Schlemm's canal with electrocautery. The ablation is performed under gonioscopic visualization with a modified direct goniolens designed for the procedure."

How it works

The Trabectome procedure starts with the creation of a 1.6-mm incision through the temporal clear cornea, followed by instillation of a small amount of viscoelastic. The Trabectome handpiece then is inserted into the anterior chamber and the goniolens is used to visualize the nasal angle. The handpiece has an irrigation port that maintains the anterior chamber during the procedure.

The handpiece is advanced to the nasal angle, the trabecular meshwork is identified, and the tip of the handpiece is inserted into the trabecular meshwork. The foot pedal is depressed to activate the aspiration and electrocautery.

The handpiece is advanced during electrocautery to create the arc of ablation, approximately 60° to 90° or more in some cases, until visualization becomes limited. The handpiece is removed from the eye, and a single 10-0 suture is placed through the incision. The total average operative time is approximately 20 to 30 minutes, which includes the preparation time.

IOP reduction

The investigators published the results from the initial 49 patients who underwent this procedure in June 2005.2 The procedure resulted in an approximate 40% reduction in IOP from the baseline in patients who were receiving the maximal tolerated medical therapy before the procedure.