Glaucoma surgery with Trabectome, using these surgical steps

Step 1
Step 1: Clear Corneal Incision
  • Create 1.8 mm clear corneal incision with slit knife
Step 1
Step 1: Clear Corneal Incision
  • Create 1.8 mm clear corneal incision with slit knife
Step 2
Step 2: Lower Anterior Chamber (AC) Intra-Ocular Pressure (IOP) to Visualize Schlemm’s Canal (SC)
  • Open corneal incision to allow aqueous humor to leave AC, lowering IOP
  • Blood refluxes into SC to promote visualization of Trabecular Meshwork (TM)
  • Reform AC by injecting Saline solution
Step 2
Step 2: Lower Anterior Chamber (AC) Intra-Ocular Pressure (IOP) to Visualize Schlemm’s Canal (SC)
  • Open corneal incision to allow aqueous humor to leave AC, lowering IOP
  • Blood refluxes into SC to promote visualization of Trabecular Meshwork (TM)
  • Reform AC by injecting Saline solution
Step 3
Step 3: Microscope Tilt and Head
  • Tilt microscope towards surgeon 40°
  • Sitting temporally, turn patient’s head away 30°
  • Best view of TM is achieved when the angle of the microscope and the patient's eye equals 70°
Step 3
Step 3: Microscope Tilt and Head
  • Tilt microscope towards surgeon 40°
  • Sitting temporally, turn patient’s head away 30°
  • Best view of TM is achieved when the angle of the microscope and the patient's eye equals 70°
Step 4
Step 4: Goniolens Placement
  • Place Goniolens on cornea and identify TM - enhanced by Step 2
  • Remove Goniolens and insert tip with irrigation on
  • Advance tip ¾ of the way across AC towards TM
  • Replace Goniolens and continue advancing tip, contacting TM
Step 4
Step 4: Goniolens Placement
  • Place Goniolens on cornea and identify TM - enhanced by Step 2
  • Remove Goniolens and insert tip with irrigation on
  • Advance tip ¾ of the way across AC towards TM
  • Replace Goniolens and continue advancing tip, contacting TM
Step 5
Step 5: Removal of Trabecular Meshwork
  • Gently insert tip into SC highlighted with blood congestion
  • Depress the foot pedal to activate aspiration and electro surgical power
  • Advance Trabectome tip clockwise within SC to remove TM
  • Bring the Trabectome tip in the center of AC and rotate 180°
  • Repeat in a counter-clockwise direction to remove TM
Step 5
Step 5: Removal of Trabecular Meshwork
  • Gently insert tip into SC highlighted with blood congestion
  • Depress the foot pedal to activate aspiration and electro surgical power
  • Advance Trabectome tip clockwise within SC to remove TM
  • Bring the Trabectome tip in the center of AC and rotate 180°
  • Repeat in a counter-clockwise direction to remove TM
Step 6
Step 6: Irrigate, Aspirate and Suture (With or Without Phaco)
  • Irrigate and Aspirate
  • If NOT combining with Phaco: Suture incision to ensure leak-tight closure
  • If combining with Phaco: Enlarge incision and proceed with Phaco, IOL insertion then suture to ensure leak-tight closure
Step 6
Step 6: Irrigate, Aspirate and Suture (With or Without Phaco)
  • Irrigate and Aspirate
  • If NOT combining with Phaco: Suture incision to ensure leak-tight closure
  • If combining with Phaco: Enlarge incision and proceed with Phaco, IOL insertion then suture to ensure leak-tight closure