Trabectome is a relatively new minimally invasive surgical procedure to treat mild to moderate open angle glaucoma. Glaucoma is a disease of the optic nerve usually caused by a build up of fluid in the eye, due to the blockage of the eye’s drainage pathways. The high intraocular eye pressure caused by the build up of fluid damages the optic nerve, causing loss of vision.
Trabectome allows the eye to drain properly, restoring its normal fluid balance. The 20-minute FDA-cleared procedure requires only mild sedation and local anesthesia (although the patient can be put under if that is preferable). Patients can expect to return home that day, and to recover within a week. Over the counter pain killers should be sufficient to deal with any post-surgery discomfort.
First, a tiny incision is made in the cornea. Then an electrosurgical pulse is used to clear away a small portion of tissue obstructing the eye’s drainage system in a part of the eye called the trabecular meshwork. The tissue debris is then washed away, and the eye can begin draining normally. The increased drainage quickly decreases pressure within the eye and stabilizes the patient’s vision.
Mayo Clinic ophthalmologist Dr. Rajeesh Shetty describes the procedure as “another rung in the treatment ladder of glaucoma”. The first rung is ophthalmic eye drops such as latanoprost drops (name brand Xalatan). Latanoprost eye drops lower eye pressure by increasing fluid drainage.
The next rung (and the first surgical rung) would be trabectome, the following rung would be laser trabeculoplasty (laser surgery to open up the eye’s drainage angle), and the final rung is trabeculectomy (a traditional surgical procedure to create a new drainage path by removing part of the trabecular meshwork).
The operation is effective, and has a low complication rate. Patients experience less need for glaucoma quit using ophthalmic eye drops altogether. Trabectome is becoming more widespread, with more and more doctors being trained to perform it, and trabectome centers opening across the world.
Trabectome is not suitable for all glaucoma patients. It is intended to treat mild to moderate glaucoma. The procedure can’t return sight lost due to glaucoma, but some patients have reported improved vision as a result of the reduction in eye pressure.
Developed by Dr. George Baerveldt at the University of California and marketed by the California company NeoMedix, the procedure was first used in the US in 2005. It is now commonly conducted in prestigious ophthalmic centers such as the Mayo Clinic, Mass Eye and Ear at Harvard, the Wilmer Eye Institute at Johns Hopkins, and the Scripps Health Institute in San Diego. Still, doctors warn that the procedure is so new there is limited data on its long-term effectiveness.
Glaucoma is the second leading cause of blindness. Called “the silent thief of vision”, in most cases it comes on slowly and insidiously, with no symptoms. The first sign of glaucoma is usually the irreversible loss of peripheral vision. That’s why it’s so important that everyone over the age of 40 be screened for glaucoma every two to four years.
Those most at risk of glaucoma – African Americans, Hispanics, diabetics, people who take corticosteroids, people that have suffered an eye injury, and those with a family history of the disease – should be screened more often.