Trabectome provides advantages in treatment of paediatric glaucoma

The trabectome is a tool which may be used to particular advantage in paediatric gluaoma patients, said Ken Nischal FRCS, UPMC Children's Hospital of Pittsburgh and Eye Center Pittsburgh, USA .

The skills required are precisely those required when performing a conventional goniotomy, namely the use of a tilted microscope and a gonioscopy lens, said Dr Nischal at a joint symposium of the European Paediatric Ophthalmology Society (EPOS) and   the World Society of Paediatric Ophthalmology and Strabismus (WSPOS), held at the XXXI Congress of the ESCRS in Amsterdam,The Netherlands.

“If you are a paediatric glaucoma surgeon who is used to doing goniotomy you already have the all the difficult parts of the procedure in your hands,”   he added.

He cited a recent study of involving 53 infantile glaucoma patients, treatment with the trabectome alone reduced mean intraocular pressure from a mean value of 27 mmHg to 19 mmHg and among seven patients who also underwent a cataract procedure pressure was reduced from 22 mmHg to 14.5 mmHg.

Dr Nischal noted that he was originally resistant to the use of a trabectome as he had been under the impression that it was a cyclocoagualative device. However, an associate of his, Nils Loewen MD at Harvard Medical School, pointed out to him that it is In fact essentially a plasma knife for performing goniotomies. 

“I don't know how long the pressure reductions achieved with the trabectome will last, but what I do know is that I misunderstood this technology and I do believe that there are children who will benefit from this, it's a question of working out who they are,” Dr Nischal added.