Steps of Trabectome
A- Pre-operative Preparation1- Consider discontinuing anticoagulation to minimize intraoperative Hyphema( bleeding in the anterior chamber) 2- Topical antibiotic to decrease the risk of post operative infection 3- Apraclonidine 0.5-1% to decrease intraocular pressure 4- Pilocarpine 1-2% to constrict the pupil for better visualization of the angle.
B- Intra-operative steps1- Sclera-corneal Incision. Small (1.7 mm) clear sclera-corneal incision is made. 2- Injection of Visco-elastic material. Injection of visco-elastic material through the incision to the anterior chamber to maintain the pressure inside the anterior chamber during the surgery. 3- Goniolens. It is a special lens that is used to localize trabecular meshwork at the angle of the eye. It is placed on the cornea. After visualization of the angle, the goniolens is removed and a tip of the Trabectome-hand piece is inserted into the angle and the goniolens is placed again on the cornea to view the angle and the tip.The hand-piece has a fluid irrigation port and a fluid aspiration port 4- Ablation. Ablation of the trabecular meshwork and the inner layer of Canal of Schlemm for (30°-60°) in clockwise direction is done with continuous irrigation and aspiration. 5- Rotation of the Tip. The tip is rotated inside the anterior chamber but away from the angle. 6- Ablation. Ablation of trabecular meshwork in anti-clockwise direction for (30°-60°). 7- Aspiration of visco-elastic material from Anterior chamber. 8- Suturing of the incision.
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C- Post-Operative Care and RecoveryTrabectome is an outpatient procedure which means the patient is able to return home when the surgery is complete. The patient’s eyes will be patched for a few hours after surgery. Normal daily activities can be performed 24 hours following surgery. Normally, you will be examined by your ophthalmologist at day 1, then seven days and 28 days after surgery. Standard Medications for Post-operation period 1- Pilocarpine 1-2% twice a day for two weeks. 2- Topical antibiotic four times a day for one week. 3- Topical steroid 4 times a day, continued as needed depending on degree of Hyphema ( Bleeding in the anterior chamber). 4- Resume glaucoma medications.
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