Glaucoma treatment with Trabectome, using these surgical steps
Step 1: Scleral Incision
Create a 1.7 mm clear corneal incision with Keratome.Step 2: Visco-elastic
Inject 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 Tip
Dis-insert tip from Schlemm’s canal and rotate instrument tip toward iris.Step 6: Ablation
Re-insert tip in the opposite direction from the initial ablation and remove a similar arc in opposite direction.Step 7: Irrigate and Aspirate
Irrigate and aspirate viscoelastic from anterior segment.Step 8: Suture
Place one suture across incision. Re-pressurize the globe.