Trabectome Surgery and Glaucoma

Trabectome surgery, a minimally invasive glaucoma procedure, involves the use of an FDA-approved handheld device. The treatment increases the amount of fluid that drains from the eye, thereby lowering eye pressure. Learn more about this surgery and important questions to ask your doctor.

The Eye Fluid Drain

Most of the aqueous humor, the fluid produced in the front of the eye, drains out of the eye via a spongy tissue located near the cornea, called the trabecular meshwork. From there, the fluid drains in a canal, which then eventually drains into to the blood circulation.

Video: How Fluid Flows Out of the Eye

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The Trabectome

In primary open-angle glaucoma, the main point of resistance for the drainage of the eye fluid is thought to be the trabecular meshwork, so its removal should help lower eye pressure. The Trabectome (which was FDA approved in 2004) is a handheld electrocautery (heated electrode) device that is used to remove a strip of trabecular meshwork along with the “inner wall” of the canal mentioned above, which is called Schlemm’s canal.  This treatment allows the eye fluid to have direct access to Schlemm’s canal.

The Trabectome procedure is usually combined with cataract surgery, and the cataract is removed from the same small incision that is made in the cornea. Because of its minimal tissue trauma, electrocautery using the Trabectome is considered a minimally-invasive glaucoma surgery.

Important Questions to Discuss with Your Doctor

• Am I a Candidate for the Trabectome Surgery?
  
  While the surgery can be performed by itself, it is more commonly combined with cataract surgery. Cataracts are typically age-related changes in the lens of the eye that cause blurry vision and glare. Therefore, while removal of the cataract will generally improve vision, the purpose of Trabectome surgery is usually either:  (a) to lower eye pressure further because eye drops or laser are not controlling it; or (b) to decrease the number of eye drops used for glaucoma. 


• How Well does the Trabectome Plus Cataract Surgery Work?
  
  On average, eye pressure will be lowered to the mid-teens range, to approximately 15 mmHg (millimeters of mercury). Typically the number of glaucoma medications is reduced, from 3 to 4 down to 1 or 2.
  
  Therefore, the Trabectome can be a very good choice for a patient who would like to decrease their number of medications and who needs a reasonable (such as mid-teens) but not very low eye pressure.


• Why Does the Electrocautery Procedure Sometimes Fail?
  
  As with most, if not all glaucoma surgeries, the most common cause of failure is scarring in the area that was treated.
  
  It is also not uncommon for blood to reflux back through Schlemm’s canal into the front of the eye; indeed this is expected when the tissue removal is successful. The bleeding is usually temporary and does not cause permanent vision loss, although it will delay how quickly you regain your vision after surgery.
  
  Larger (and sometimes even smaller) bleeds can cause inflammation, which increases the risk of scarring.
  
  Other complications include postoperative eye pressure spikes, which will be monitored by your surgeon. Rare complications include the improper location of tissue removal or more robust bleeding.


• What if the Trabectome Surgery Does Not Control Your Eye Pressure Enough?
  
  Eye drops may be added back to your treatment plan after your surgery in an effort to control the eye pressure or prevent postoperative pressure spikes. Because the Trabectome is a minimally-invasive glaucoma surgery, if it fails to control the eye pressure, traditional surgeries such as trabeculectomy or tube shunt surgery can be done. Having previously had the Trabectome electrocautery surgery does not affect the success of these traditional surgeries.


• Are there Other Minimally-Invasive Glaucoma Surgeries that are Similar to Electrocautery or Trabectome?
  
  The surgery we have discussed in this article is a “trabecular bypass” surgery that could be compared to other options, including the Kahook dual blade, GATT (gonioscopy-assisted transluminal trabeculotomy), or Trab 360. However, each of these surgeries has their own nuances, and it is recommended that you discuss these possibilities with your surgeon.