Glaucoma treatment with Trabectome, using these surgical steps
Step 1: Scleral IncisionCreate a 1.7 mm clear corneal incision with Keratome.
Step 2: Visco-elasticInject a small amount of viscoelastic at incision site for easy entry of tip into anterior chamber.
Step 3: Goniolens Placement
- Place Goniolens on cornea and verify angle view.
- Remove Goniolens and insert tip past the irrigation ports.
- Replace Goniolens and activate continuous irrigation.
- Advance tip across anterior chamber under direct view.
Step 4: Ablation
- Insert tip into Schlemm’s canal anterior to the scleral spur in either a clockwise or counter-clockwise direction.
- Depress the foot pedal to activate aspiration and ablation, while advancing the instrument within Schlemm’s canal.
- Ablate the trabecular meshwork for approximately one-to-two clock hours (30°-60°).
Step 5: Rotate TipDis-insert tip from Schlemm’s canal and rotate instrument tip toward iris.
Step 6: AblationRe-insert tip in the opposite direction from the initial ablation and remove a similar arc in opposite direction.
Step 7: Irrigate and AspirateIrrigate and aspirate viscoelastic from anterior segment.
Step 8: SuturePlace one suture across incision. Re-pressurize the globe.