Articles

Ab interno trabecular meshwork incision, ablation, and disruption

Author(s):

Hamed Esfandiari

Ralitsa T. Loewen

Abstract:

Ab interno disruption and ablation of the trabecular meshwork (TM) increases outflow at the level of the juxtacanalicular TM and the inner wall of Schlemm’s canal (SC). This resistance was mostly bypassed by external glaucoma surgeries in the past (i.e. trabeculectomies and tube shunts). Recent studies have also validated the use of ab interno TM disruption in more advanced glaucoma and additional types of glaucoma. Techniques and instruments discussed in this chapter include: trabecular incision in classic goniotomy; trabecular ablation using the Trabectome; trabecular excision using the Goniotome; Goniotome with irrigation and aspiration; the Kahook Dual Blade; trabecular disruption by endoscopic laser trabeculotomy; the Tanito microhook; and catheter or suture-assisted transluminal trabeculotomy. The concept behind each procedure is discussed first, followed by the methods and pearls that we have developed over several years to excel at each of them. A literature review is provided to evaluate and summarize the efficacy and safety of each procedure and its place compared to other MIGS.

New Concepts in Glaucoma Surgery Series: Volume 1, pp. 137-156 #10
Edited by: John R. Samples and Iqbal Ike K. Ahmed
© Kugler Publications, Amsterdam, The Netherlands

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