Different from cautery, the tip generates plasma to molecularize the trabecular meshwork and remove it drag-free and with minimal thermal effect.
Active irrigation of the trabectome surgery system helps to keep the anterior chamber formed during the procedure and precludes the need for ophthalmic viscoelastic devices.
The deep venous plexus distal to the outer wall of Schlemm's canal, the iris root, the ciliary body band and the suprachoroidal space all risk being damaged during surgery.
To master this surgery, it is important to be able to visualize the angle, identify the correct target, avoid trauma and maximize meshwork removal.
A disadvantage of this method is that over time, diffusion also takes place through intact vascular endothelium, staining the extravascular space.
These include positioning the patient's head, setting up the microscope, gonioscopic visualization of the angle and identification of Schlemm's canal.
For the surgery to be performed correctly, the patient's headrest must be close enough to the microscope stand to accommodate the tilted view, and greater distance from it.
Schlemm's canal should be identified by using a 0.12 forceps to tap lightly on the posterior lip of the primary cataract incision, creating blood reflux.
It can also cause fluorescein to flow circumferentially, through small connections between Schlemm's canal-like segments, typical of a pig's angular aqueous plexus [3-5].
Reconstruction of outflow tracts via spectral domain optical coherence tomography have confirmed a correlation between aqueous spaces and collectors where flow was seen.
Electron microscopic images of the outer wall suggest that most are removed during trabectome procedures, together with their attachments and the trabecular meshwork [30].
Studies have shown that lens status or performance of phacoemulsification in the same session has no significant impact on intraocular pressure reduction [38,39].
These results suggest that trabectome surgery is a viable option for patients with narrow angles [15] Reoperation after failed trabeculectomy or tube shunt is very challenging.
Studies of patients undergoing trabectome surgery after a failed tube shunt have shown a statistically significant reduction in intraocular pressure after one year [42].
Further research has shown trabectome surgery after failed trabeculectomy to result in an intraocular pressure reduction of 36%, and a 14% decrease in the number of pressure-lowering medications.
Other factors which have been linked to intraocular pressure reduction are age, Hispanic ethnicity, steroid-induced glaucoma and cup disk ratio [37].
Recent research has shown the most common complications to include hyphema, peripheral anterior synechiae, corneal injury and temporary spikes in intraocular pressure.
Less common complications include transient hypotony lasting less than 3 months, iris injury, cystoid macular edema and cataract progression.
There are case reports of a few, rare complications, including cyclodialysis cleft, aqueous misdirection, choroidal hemorrhage and endophthalmitis [18].
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