Novel surgical procedures in glaucoma: Advances in penetrating glaucoma surgery

Glaucoma Consultation Service, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts 02048, USA.
Current Opinion in Ophthalmology (Impact Factor: 2.64). 04/2008; 19(2):149-54. DOI: 10.1097/ICU.0b013e3282f4f49e
Source: PubMed

ABSTRACT Despite late modifications and enhancements, traditional penetrating glaucoma surgery is not without complications and is reserved for patients in whom pharmacologic treatment and/or laser trabeculoplasty do not suffice to control the intraocular pressure. This article critically reviews recent advances in penetrating glaucoma surgery with particular attention paid to two novel surgical approaches: ab interno trabeculectomy with the Trabectome and implantation of the Ex-PRESS shunt.
Ab interno trabeculectomy (Trabectome) achieves a sustained 30% reduction in intraocular pressure by focally ablating and cauterizing the trabecular meshwork/inner wall of Schlemm's canal. It has a remarkable safety profile with respect to early hypotonous or infectious complications as it does not generate a bleb, but it can be associated with early postoperative intraocular pressure spikes that may necessitate additional glaucoma surgery. The Ex-PRESS shunt is more commonly implanted under a partial thickness scleral flap, and appears to have similar efficacy to standard trabeculectomy offering some advantages with respect to the rate of early complications related to hypotony.
Penetrating glaucoma surgery will continue to evolve. As prospective randomized clinical trials become available, we will determine the exact role of these surgical techniques in the glaucoma surgical armamentarium.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Histocompatibility antigen typing was carried out in 50 Caucasian patients with primary open-angle glaucoma (POAG) and 50 Caucasian ocular-normotensive subjects. HLA-A 3 was present in 46%, B7 in 52%, B12 in 50%, and either B7 or B12 in 88% of p,tients with POAG. These prevalences in POAG patients were significantly greater than in ocular-normotensive subjects (p less than 0.01, p less than 0.0005, p less than 0.001, and p less than less than 0.0005, respectively). The prevalences of A 3-B 7, A 3-B 12 and either combination were also significantly greater in POAG patients than in the ocular normotensives (p less than 0.005, p less than 0.005, and p less than 0.0005, respectively). HLA-BW 35 was noted to be in deficit in Caucasian POAG patients (8%) as compared to Caucasian ocular normotensives (32%; p less than 0.01).
    International archives of allergy and applied immunology 02/1977; 55(1-6):546-50. DOI:10.1159/000231970
  • [Show abstract] [Hide abstract]
    ABSTRACT: Glaucoma is a group of diseases that lead to the loss of retinal ganglion cells and damage to the optic nerve with associated visual function loss. The primary risk factor is elevated intraocular pressure and therapy is directed toward lowering the pressure through medical and surgical interventions. The Trabectome™ is a novel device used to remove a portion of the trabecular meshwork and inner layer of Schlemm's canal within the anterior chamber to allow for increased aqueous outflow. It is similar to trabeculotomy, with the primary difference being the permanent ablation and removal of trabecular meshwork tissue rather than a simple incision through this tissue. It offers a safer and more efficient procedure than the current gold standard, filtering surgery, while still providing reduction of intraocular pressure without reports of vision-threatening complications. Therefore, it can be offered earlier in patient management, as well as in conjunction with cataract extraction. Trabeculotomy was previously only reserved for treatment of congenital glaucoma, but the Trabectome has demonstrated its effectiveness in adults with open-angle glaucoma.
    Expert Review of Ophthalmology 03/2009; 4(2):119-128. DOI:10.1586/eop.09.8
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Outflow procedures for glaucoma surgery have remained popular in the last decade, including trabeculectomy, glaucoma drainage devices, and deep sclerectomy/viscocanalostomy. In the last few years, the surgical armamentarium for glaucoma has vastly increased. Surgeons are using more procedures aimed at creating bleb-free surgery. Schlemm's canal surgery is experiencing a renaissance. This article concentrates on three of the more commonly performed canal procedures: trabeculotomy ab interno (Trabectome), Canaloplasty, and trabeculotomy ab externo. Trabeculotomy ab interno performed with the Trabectome has been shown to lower intraocular pressure (IOP) almost 40% by 12 months with minimal complications. Trabectome alone, as well as combined with cataract surgery, appears to lower IOP quite well. Canaloplasty has also been shown to lower IOP by 38% and combined with cataract surgery, IOP was lowered 44% at 24 months. Trabeculotomy lowers IOP well, especially in older adults. Phacotrabeculotomy lowers IOP to 21 mmHg or less in 84% of patients with supplemental use of medications, and in 36% of patients without at 3 years. Canal surgery has proven to be an alternative to traditional glaucoma surgery, lowering IOP relatively well. Surgeons must be comfortable with the anatomy and proceed with the procedure in eyes that are amenable to various new surgical advances.
    Current opinion in ophthalmology 04/2009; 20(2):116-21. DOI:10.1097/ICU.0b013e32831eef65 · 2.64 Impact Factor
Show more


Available from