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Klin Monbl Augenheilkd 2015; 232(3): 303-309
DOI: 10.1055/s-0034-1383014
Übersicht
Georg Thieme Verlag KG Stuttgart · New York

Minimalinvasive Kammerwinkelchirurgie mit dem Trabektom

Minimally Invasive Glaucoma Surgery using the Trabectome
T. Wecker
Klinik für Augenheilkunde, Universitätsklinikum Freiburg
,
J. F. Jordan
Klinik für Augenheilkunde, Universitätsklinikum Freiburg
› Author Affiliations
Further Information

Publication History

eingereicht 26 May 2014

akzeptiert 23 July 2014

Publication Date:
01 October 2014 (online)

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Zusammenfassung

Das Trabektom ist ein Instrument zur Elektroablation des beim Glaukom pathologisch veränderten juxtakanalikulären Trabekelmaschenwerks. Der Schlemm-Kanal wird zur Vorderkammer eröffnet, wodurch der Abfluss von Kammerwasser in das intra- und episklerale Gefäßsystem ermöglicht wird. In den bisher veröffentlichten Studien zum Trabektom wird eine Drucksenkung von im Mittel 30 % und eine simultane Medikamentenreduktion um 42 % berichtet. Das Trabektom ist bei primären und sekundären Offenwinkelglaukomen einsetzbar, wobei sich bei Pseudoexfoliationsglaukomen eine besonders gute Wirksamkeit zeigt. Durch seinen wenig invasiven und vor allem bindehautneutralen Operationszugang ist das Trabektom zudem besonders gut geeignet bei Patienten mit chronischen Erkrankungen der Augenoberfläche. Der operative Zugang erfolgt über einen kornealen Tunnel. Der Eingriff mit dem Trabektom lässt sich über einen Zugangsweg gut mit einer Phakoemulsifikation und Hinterkammerlinsenimplantation kombinieren. In den bisherigen Studien zeigte sich keine über das allgemeine Risiko eines bulbuseröffnenden Eingriffs hinausgehende Rate ernster Komplikationen. Das Trabektom stellt eine sichere und effektive Methode der operativen Augeninnendrucksenkung bei Patienten mit Offenwinkelglaukom und einem Zieldruckniveau um 16 mmHg dar.

Abstract

The main barrier reducing outflow of aqueous humor in open angle glaucomas is the juxtacanalicular trabecular meshwork. The trabectome removes this pathophysiologically altered tissue by electroablation, thus allowing for the collector channels draining Schlemmʼs canal to directly communicate with the anterior chamber. In studies published so far, about 30 % decrease of intraocular pressure and a simultaneous 42 % reduction of pressure-lowering eyedrops could be achieved in primary and secondary open angle glaucomas. A clear cornea tunnel is used to advance the trabectome to the trabecular meshwork, leaving the conjunctiva unaffected. Hence minimally invasive chamber angle surgery using this device is in particular suitable for patients with an altered ocular surface. Lowering of intraocular pressure and reduction of needed topical medication seems to be distinct in pseudoexfoliative glaucoma. Surgery with the trabectome and phacoemulsification can easily be combined in one procedure. Using a minimally invasive approach, the complication profile of the trabectome is rather advantageous, not exceeding the general risks of globe-opening surgery. Ab-interno trabeculotomy is a safe and effective method for treatment of patients with primary or secondary open angle glaucomas and moderate target pressures.

Schlüsselwörter

Glaukom - minimalinvasive Kammerwinkelchirurgie - Trabektom

Key words

glaucoma - minimally invasive glaucoma surgery - trabectome
 

  • Literatur

  • 1 Baerveldt G, Chuck R. Minimally invasive glaucoma surgical instrument and method.. US Patent 6979328, 2005
    PubMedGoogle Scholar
  • 2 WuDunn D. Mechanobiology of trabecular meshwork cells. Exp Eye Res 2009; 88: 718-723
    CrossrefPubMedGoogle Scholar
  • 3 Schlunck G, Han H, Wecker T et al. Substrate rigidity modulates cell matrix interactions and protein expression in human trabecular meshwork cells. Invest Ophthalmol Vis Sci 2008; 49: 262-269
    CrossrefPubMedGoogle Scholar
  • 4 Selbach JM, Gottanka J, Wittmann M et al. Efferent and afferent innervation of primate trabecular meshwork and scleral spur. Invest Ophthalmol Vis Sci 2000; 41: 2184-2191
    PubMedGoogle Scholar
  • 5 Tektas OY, Lütjen-Drecoll E. Structural changes of the trabecular meshwork in different kinds of glaucoma. Exp Eye Res 2009; 88: 769-775
    CrossrefPubMedGoogle Scholar
  • 6 Wecker T, Han H, Börner J et al. Effects of TGF-β2 on cadherins and β-catenin in human trabecular meshwork cells. Invest Ophthalmol Vis Sci 2013; 54: 6456-6462
    CrossrefPubMedGoogle Scholar
  • 7 Kagemann L, Wollstein G, Ishikawa H et al. Visualization of the conventional outflow pathway in the living human eye. Ophthalmology 2012; 119: 1563-1568
    CrossrefPubMedGoogle Scholar
  • 8 Hann CR, Bentley MD, Vercnocke A et al. Imaging the aqueous humor outflow pathway in human eyes by three-dimensional micro-computed tomography (3D micro-CT). Exp Eye Res 2011; 92: 104-111
    CrossrefPubMedGoogle Scholar
  • 9 Tamm ER. Funktionelle Morphologie der Abflusswege des Kammerwassers und ihre Veränderungen beim Offenwinkelglaukom. Ophthalmologe 2013; 110: 1026-1035
    CrossrefPubMedGoogle Scholar
  • 10 Rulli E, Biagioli E, Riva I et al. Efficacy and safety of trabeculectomy vs. nonpenetrating surgical procedures: a systematic review and meta-analysis. JAMA Ophthalmol 2013; 131: 1573-1582
    CrossrefPubMedGoogle Scholar
  • 11 Zhou J, Smedley GT. A trabecular bypass flow hypothesis. J Glaucoma 2005; 14: 74-83
    CrossrefPubMedGoogle Scholar
  • 12 Sit AJ, McLaren JW. Measurement of episcleral venous pressure. Exp Eye Res 2011; 93: 291-298
    CrossrefPubMedGoogle Scholar
  • 13 Barkan O. Operation for congenital glaucoma. Am J Ophthalmol 1942; 25: 552-568
    CrossrefPubMedGoogle Scholar
  • 14 Barkan O. A new operation for chronic glaucoma. Restoration of physiological function by opening Schlemmʼs canal under direct magnified vision. Am J Ophthalmol 1936; 19: 951-955
    CrossrefPubMedGoogle Scholar
  • 15 Harms H, Dannheim R. Epicritical consideration of 300 cases of trabeculotomy ‘ab externo . Trans Ophthalmol Soc U K 1970; 89: 491-499
    PubMedGoogle Scholar
  • 16 Jacobi PC, Dietlein TS, Krieglstein GK. Technique of goniocurettage: a potential treatment for advanced chronic open angle glaucoma. Br J Ophthalmol 1997; 81: 302-307
    CrossrefPubMedGoogle Scholar
  • 17 Minckler D, Baerveldt G, Ramirez MA et al. Clinical results with the Trabectome, a novel surgical device for treatment of open-angle glaucoma. Trans Am Ophthalmol Soc 2006; 104: 40-50
    PubMedGoogle Scholar
  • 18 Francis BA, See RF, Rao NA et al. Ab interno trabeculectomy: development of a novel device (Trabectome) and surgery for open-angle glaucoma. J Glaucoma 2006; 15: 68-73
    CrossrefPubMedGoogle Scholar
  • 19 Allingham RR, de Kater AW, Ethier RC. Schlemmʼs canal and primary open angle glaucoma: correlation between Schlemmʼs canal dimensions and outflow facility. Exp Eye Res 1996; 62: 101-110
    CrossrefPubMedGoogle Scholar
  • 20 Jordan JF. [Minimally invasive iridocorneal angle surgery]. Ophthalmologe 2012; 109: 713-723 (quiz 724)
    CrossrefPubMedGoogle Scholar
  • 21 Saheb H, Ahmed IIK. Micro-invasive glaucoma surgery: current perspectives and future directions. Curr Opin Ophthalmol 2012; 23: 96-104
    CrossrefPubMedGoogle Scholar
  • 22 Dietlein TS. [Glaucoma in the aged–barriers to understanding and compliance]. Ophthalmologe 2006; 103: 755-758
    CrossrefPubMedGoogle Scholar
  • 23 Dietlein TS, Jordan JF, Lüke C et al. Self-application of single-use eyedrop containers in an elderly population: comparisons with standard eyedrop bottle and with younger patients. Acta Ophthalmol 2008; 86: 856-859
    CrossrefPubMedGoogle Scholar
  • 24 Gupta R, Patil B, Shah BM et al. Evaluating eye drop instillation technique in glaucoma patients. J Glaucoma 2012; 21: 189-192
    CrossrefPubMedGoogle Scholar
  • 25 Fechtner RD, Godfrey DG, Budenz D et al. Prevalence of ocular surface complaints in patients with glaucoma using topical intraocular pressure-lowering medications. Cornea 2010; 29: 618-621
    PubMedGoogle Scholar
  • 26 Servat JJ, Bernardino CR. Effects of common topical antiglaucoma medications on the ocular surface, eyelids and periorbital tissue. Drugs Aging 2011; 28: 267-282
    CrossrefPubMedGoogle Scholar
  • 27 Minckler D, Mosaed S, Dustin L et al. Trabectome (trabeculectomy-internal approach): additional experience and extended follow-up. Trans Am Ophthalmol Soc 2008; 106: 149-159 (discussion 159–160)
    PubMedGoogle Scholar
  • 28 Mosaed S. The first decade of global trabectome outcomes. Clin Surg Ophthalmol 2014; 32: 21-29
    PubMedGoogle Scholar
  • 29 Ting JLM, Damji KF, Stiles MC. Ab interno trabeculectomy: outcomes in exfoliation versus primary open-angle glaucoma. J Cataract Refract Surg 2012; 38: 315-323
    CrossrefPubMedGoogle Scholar
  • 30 Jordan JF, Wecker T, van Oterendorp C et al. Trabectome surgery for primary and secondary open angle glaucomas. Graefes Arch Clin Exp Ophthalmol 2013; 251: 2753-2760
    CrossrefPubMedGoogle Scholar
  • 31 Klamann MKJ, Gonnermann J, Maier AKB et al. Influence of Selective Laser Trabeculoplasty (SLT) on combined clear cornea phacoemulsification and Trabectome outcomes. Graefes Arch Clin Exp Ophthalmol 2014; 252: 627-631
    CrossrefPubMedGoogle Scholar
  • 32 Ahuja Y, Ma Khin Pyi S, Malihi M et al. Clinical results of ab interno trabeculotomy using the trabectome for open-angle glaucoma: the Mayo Clinic series in Rochester, Minnesota. Am J Ophthalmol 2013; 156: 927.e2-935.e2
    PubMedGoogle Scholar
  • 33 Mosaed S, Rhee DJ, Filippopoulos T et al. Trabectome outcomes in adult open angle glaucoma patients: one year follow up. Clin Surg Ophthalmol 2010; 28: 8
    PubMedGoogle Scholar
  • 34 Morales J, Al Shahwan S, Al Odhayb S et al. Current surgical options for the management of pediatric glaucoma. J Ophthalmol 2013; 2013: 763735
    PubMedGoogle Scholar
  • 35 Pantcheva MB, Kahook MY. Ab interno trabeculectomy. Middle East Afr J Ophthalmol 2010; 17: 287-289
    CrossrefPubMedGoogle Scholar
  • 36 Maeda M, Watanabe M, Ichikawa K. Evaluation of trabectome in open-angle glaucoma. J Glaucoma 2013; 22: 205-208
    CrossrefPubMedGoogle Scholar
  • 37 Ahuja Y, Malihi M, Sit AJ. Delayed-onset symptomatic hyphema after ab interno trabeculotomy surgery. Am J Ophthalmol 2012; 154: 476.e2-480.e2
    PubMedGoogle Scholar
  • 38 Vold SD, Dustin L. Trabectome Study Group. Impact of laser trabeculoplasty on Trabectome® outcomes. Ophthalmic Surg Lasers Imaging 2010; 41: 443-451
    CrossrefPubMedGoogle Scholar
  • 39 Töteberg-Harms M, Rhee DJ. Selective laser trabeculoplasty following failed combined phacoemulsification cataract extraction and ab interno trabeculectomy. Am J Ophthalmol 2013; 156: 936.e2-940.e2
    PubMedGoogle Scholar
  • 40 Jea SY, Mosaed S, Vold SD et al. Effect of a failed trabectome on subsequent trabeculectomy. J Glaucoma 2012; 21: 71-75
    PubMedGoogle Scholar
  • 41 Minckler DS, Baerveldt G, Alfaro MR et al. Clinical results with the Trabectome for treatment of open-angle glaucoma. Ophthalmology 2005; 112: 962-967
    CrossrefPubMedGoogle Scholar
  • 42 Francis BA, Minckler D, Dustin L et al. Combined cataract extraction and trabeculotomy by the internal approach for coexisting cataract and open-angle glaucoma: initial results. J Cataract Refract Surg 2008; 34: 1096-1103
    CrossrefPubMedGoogle Scholar
  • 43 Van Oterendorp C, Ness T, Illerhaus G et al. The trabectome as treatment option in secondary glaucoma due to intraocular lymphoma. Glaucoma 2012; DOI: 10.1097/IJG.0b013e31827a0875. [Epub ahead of print] DOI: 10.1097/IJG.0b013e31827a0875.
    PubMedGoogle Scholar