Trabectome ™

Introduction

The Trabectome ^™ device is FDA cleared in the USA, and has regulatory approval in many countries worldwide for the treatment of adult and juvenile glaucoma. The device is a micro-electro handpiece with irrigation and aspiration components, designed to ablate the trabecular meshwork and inner wall of Schlemm's canal ( Figs 125-1 and 125-2 ). This ab interno trabeculotomy is considered a trabecular bypass procedure and appears to be gaining in popularity over recent years.

The scientific rationale behind this procedure involves the same concept as a goniotomy whereby a small incision is made in the clear cornea and the trabecular meshwork (TM) is cut under gonioscopic visualization to allow the aqueous into Schlemm's canal, thereby bypassing the trabecular meshwork, long thought to be the main site of resistance to aqueous outflow. The main difference between the Trabectome ^™ and standard goniotomy is that the Trabectome ^™ ablates and removes a strip of trabecular meshwork without damaging the outer wall of Schlemm's canal with its protective footplate, shown in Figure 125-2 . The standard goniotomy involves cutting the TM, after which the cut ends are in apposition to one another where fibrosis and closure of the incision limits the long-term success of goniotomy in adults. The Trabectome ^™ ablates the TM and inner wall of Schlemm's canal, creating a cleft or space where there is no apposition of tissues, and closure is theoretically less likely as shown in these electronic scanning microscope images ( Fig. 125-3 ).