n this brief but informative Continued Medical Education (CME) presentation for physicians, the Discovery Channel talks to Nils Loewen, MD, of the University of Pittsburgh's Ophthalmology Department about a revolutionary approach to the treatment of glaucoma. This is an excellent and easy-to-understand introduction to the Trabectome technology as well as some insights by one of the nation's greatest ophthalmology surgeons. Nils Loewen, MD,PhD, has one focus; the trabecular meshwork. In the clinic, Dr. Loewenperforms a range of minimally invasive surgical proceduresto remove or bypassfaulty trabecular meshwork,restoring the eye's ability to drain fluid. In the lab, his goals are to understand why the trabecular meshwork fails in glaucoma and to developbiologic tools to regenerate it with healthy tissue. Dr. Loewen is among the most experienced surgeons in the United States inTrabectome surgery, and has performed the procedure more than 600 times. In Trabectome surgery, a strip of the trabecular meshwork and the inner wall of Schlemm's Canal are removed via plasma ablation to re-establish access to the eye's natural drainage pathway. Compared with conventional trabeculectomy, Dr. Loewen adds that Trabectome surgery is less invasive and often offers a higher success rate, a lower risk of post surgical and long-term complications, anda quicker recovery for the patient. "Hello, I'm Dr. John Whyte, Chief Medical Expert of the Discovery Channel. Trabectome surgery is a newer minimally invasive procedure for the treatment of glaucoma, a chronic long term disease in which intraocular pressure rises causing damage to the optic nerve. While the gold standard for glaucoma treatment is currently Trabeculectomy, Dr. Nils Loewen of UPMC believes Trabectome surgery often offers less risk and better outcomes. Dr. Loewen: "The standard of care in glaucoma is oftentimes treatment with laser and eye drops before more invasive modalities are chosen. Trabeculectomy used to then be the gold standard for immense glaucoma or the glaucoma drainage device in form of the so called tube shunt. Now, I would also recommend to do a minimally invasive glaucoma surgery first and that is the Trabectome. In Trabectome surgery we're unroofing an opening of the natural drainage system, removing the literally primary pathology in glaucoma, which is an alpha resistance in the trabecular meshwork that's guarding the intake in Schlemm's canal. So the difference is it is a new surgery that is minimally invasive but it also has a large body of experience and we know that the safety records is very good. The instrument looks sort of like a pencil. It has, that's only the handle itself. Out of the handle comes a tip that has a diameter of about 1.6 millimeters and an ablation tip that is approximately 300 microns wide. That allows to engage this lacey thin structure that the trabecular meshwork is without damaging it. In the surgery, the eyes are numbed up with numbing drops and then the patients head is rotated to the side, the structure is visualized with a specialized lens called the gonio lens; the Trabectome is inserted to engage specifically only the diseased tissue in the trabecular meshwork and that tissue is then ablated over an arc of 120-180 degrees to then free flow into the natural drainage system. The benefits are the speed and it's much less invasive, and no hardware is left behind in the eye that tends to erode away in other glaucoma surgeries, and no antimetabolites are used that can progressively damage the thin wall even ten years down the road. So there is no long term harm. But also in our own data we see that the success rate is much higher and that is probably the biggest surprise to glaucoma surgeons. It takes a while to get really good with this procedure but our success rate with one year is 95%. I could never achieve this with Trabeculectomy. This is the surgery that's very easy to combine with cataract surgery in the same session. So you can deliver lower pressure and improved function to the same patient in one session. In addition to that, performing cataract surgery also improves the success rate. That's what our data suggests. It probably does so by deepening the angle where the drainage occurs so scar tissue is less slightly deformed. You just have to know that Trabectome surgery is a very safe and very effective procedure that can deliver results that are very similar to Trabeculectomy but are safer to achieve, the surgery is shorter, and at the same time better vision, which is so important for patients, can be delivered in the same surgery." Trabectome surgery is a valuable tool that glaucoma surgeons armamentarium. By using the natural drainage system o the eye, surgeons can offer patients a minimally invasive procedure with higher success rates than the traditional Trabeculectomy."

• published: 26 Sep 2014
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