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Trabectome-Mediated Ab Interno Trabeculectomy for Secondary Glaucoma or as a Secondary Procedure

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Advanced Glaucoma Surgery

Part of the book series: Essentials in Ophthalmology ((ESSENTIALS))

Abstract

Ab interno trabeculectomy with the trabectome (Neomedix, Tustin, CA) is an established minimally invasive glaucoma surgery with surgical results first reported in 2005. This plasma surgery ablates the trabecular meshwork to increase conventional outflow via its physiological route. We discuss the surgical technique, indications, results, and complications of trabectome as a primary surgery in secondary glaucomas, as a surgery in glaucomas with narrow angles, as a secondary surgery after failed trabeculectomy and tube shunt, and as an adjunctive surgery at the time of tube shunt implantation. Trabectome can be expected to decrease the intraocular pressure (IOP) to a postoperative mean IOP of 16 mmHg without a direct relationship to preoperative pressures. Among secondary glaucomas, pseudoexfoliation glaucoma stands out as achieving even lower IOPs than in primary open angle glaucoma. Preliminary evidence suggests that comparable results can also be achieved with other secondary forms of glaucoma, including inactive neovascular, uveitic, traumatic, and postsurgical glaucoma, as well as following a failed trabeculectomy. Trabectome as an adjunctive step in tube shunt implantation with a tube that is completely tied off and not fenestrated can safely achieve lower IOPs than each surgery on its own but avoids the hypertensive phase. Vision-threatening complications are limited to case reports at the current time. Trabectome offers an effective and safe option for a wide range of glaucomas.

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Acknowledgements

Compliance with Ethical Requirements

Conflict of Interest: Kevin Kaplowitz declares no conflict of interest. Nils Loewen is a trabectome trainer for Neomedix.

Informed Consent: No human or animal studies were carried out by the authors for the writing of this chapter.

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Authors and Affiliations

  1. Department of Ophthalmology, Stony Brook University Hospital Medical Center, Stony Brook, NY, USA

    Kevin Kaplowitz M.D.

  2. Department of Ophthalmology, University of Pittsburgh, Pittsburgh, PA, USA

    Nils A. Loewen M.D., Ph.D.

Authors
  1. Kevin Kaplowitz M.D.
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  2. Nils A. Loewen M.D., Ph.D.
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Correspondence to Kevin Kaplowitz M.D. .

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Editors and Affiliations

  1. Illinois Eye & Ear Infirmary, University of Illinois at Chicago School of Medicine, Chicago, Illinois, USA

    Ahmad A. Aref

  2. Southern California, LA, CA, USA, USC Eye Ins.Dept. of Ophth. Univ.of Southern California, LA, CA, USA, California, California, USA

    Rohit Varma

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Trabectome procedure with Goniosynechiolysis (MP4 51520 kb)

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Kaplowitz, K., Loewen, N.A. (2015). Trabectome-Mediated Ab Interno Trabeculectomy for Secondary Glaucoma or as a Secondary Procedure. In: Aref, A., Varma, R. (eds) Advanced Glaucoma Surgery. Essentials in Ophthalmology. Springer, Cham. https://doi.org/10.1007/978-3-319-18060-1_3

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  • DOI: https://doi.org/10.1007/978-3-319-18060-1_3

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18059-5

  • Online ISBN: 978-3-319-18060-1

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