TrabectomeTM Perspectives Laboratory in vitro TrabectomeTM

TM
Trabectome
Clinical Results with the
for treatment of Open-angle Glaucoma
[In press: Ophthalmology; Dec. 2004]
Don S. Minckler, MD,1 George Baerveldt, MD,2 Marina Ramirez Alfaro, MD,3 and Brian A. Francis, MD1
1Doheny Eye Institute, Keck School of Medicine, University of Southern California, Los Angeles, California.
2 University of California, Irvine, 3 Codet Eye Institute, Tijuana, Mexico
TM
Trabectome
Goniotomy – Effective only in Children
(Illustrations: Becker-Shaffer’s Diagnosis &
Therapy of the Glaucomas 5th Ed., Mosby, 1983,
page 494-5.)
•View of Angle/Meshwork
through surgical lens
TrabectomeTM
Anatomy of the Anterior Chamber Angle
Pre-op IOP=28.2 ± 4.4 mmHg (n=42)
18 months post-op IOP = 16.0 ± 1.6 mmHg (n=11)
32
30
•Masson’s
Trichrome
28
26
24
IOP (mmHg)
22
20
18
16
14
12
10
8
6
4
Trabeculotomy – Option
when visualization poor
Laboratory in vitro
•Pseudoexfoliation: 8
•Pigment Dispersion: 2
•Steroid-induced: 1
•Previous trabeculectomy 1; pseudophakic 1
•Main difficulty is
Identifying Schlemm’s
•Possible conversion
to trabeculectomy
Becker-Shaffer’s
Diagnosis & Therapy of the
Glaucomas, 5th Ed., Mosby,
1983, page 475.
•17 male & 20 female Hispanic/White adults age 61 + 11
years; failing medical therapy, healthy, COAG & sub-types:
ƒVFD/Disc advanced (C/D > 0.8 in 15; VFD in 3/4 quadrants
in 27)
•Inverted
corneal
donor rim
in suction
device
•Initial lens status
• Phakic without cataract: 24
•With mild cataract: 12
• No. of Meds. (pre op): 1.2 + 0.6 (n = 34 patients)
• No. of Meds. (last visit): 0.13 + 0.6 (n = 14 patients)
TrabectomeTM
Console/handpiece
Unroofed Schlemm’s
TrabectomeTM
Initial case series (first 37 patients)
•Intraoperative blood reflux in all cases:
•Hyphema cleared by 6.4 + 4.1 days
•20% hyphema largest in this series
•Minimized by wound suture/air tamponade
•2% Pilocarpine pre-op & 2 – 6 weeks post-op
•Transient Corneal injuries: 6/37 (16.2%)
•Epithelial defect: 3/37
•Decemet’s hemorrhage: 1/37
•Decemet’s scroll/detach: 1/37
•Persisting Decemet’s injury: 1/37
(8.1%)
(2.7%)
(2.7%)
(2.7%)
•Partial PAS/goniosynechiae: 14/37 (38%)
TrabectomeTM
TrabectomeTM Perspectives
•Potentially safer/easier than trabeculectomy
•? Fits into therapeutic spectrum between laser and
trabeculectomy
•Potential alternative to goniotomy/trabeculotomy in
children
•Relatively easy skill transfer
Surgical Data (extended to 42 patients)
CB hinged forward
See RF et al: ARVO 2003: A [control]; B [goniotomy];
C: confocal image after goniotomy; D: TrabectomeTM
Pre-Op
1 day
7 day
1 month
3 months
6 months
9 months
12 months
18 months
28.2 mm Hg ± 4.3
18.3 mm Hg ± 10.6
17.8 mm Hg ± 5.8
17.1 mm Hg ± 5.4
17.9 mm Hg ± 4.1
17.6 mm Hg ± 3.4
15.8 mm Hg ± 2.6
16.3 mm Hg + 2.0
16.0 mm Hg + 1.6
n=42
n=42
n=42
n=42
n=42
n=31
n=26
n=19
n=11
0
1
2
3
4
5
6
7
8
9 10 11 12 13 14 15 16 17 18 19 20
Months After Surge ry
References:
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ACKNOWLEDGEMENTS:
Supported in part by National Institutes of Health grants EY03040 and
EY015037 and by an unrestricted grant from Research to Prevent
Blindness, New York, New York and by NeoMedix Corporation.4