“Ab Interno” Surgery of the Schlemm’s Canal in Postuveitic Glaucoma Patients

Abstract

Background: Patients with uveitis have a higher risk of developing glaucoma not only because of the disease by itself, but also because of the ongoing corticosteroid therapy. The pathogenesis of uveitic glaucoma is characterized by a complex of biochemical and cellular processes, as well as morphological changes in the trabecular meshwork. Treatment of secondary chronic glaucoma is challenging and often requires different approaches and solutions. Purpose: To present the “ab interno” procedure of the Schlemm‘s canal (SC) performed with the help of TrabEx+ (MST, Redmond, WA, USA) in postuveitic glaucoma patients. Methods: The observed group included patients with postuveitic secondary glaucoma, which consisted of 12 pseudophakic patients (12 eyes). Patients are with intraocular pressure higher than 25 mmHg and on maximal local therapy. Due to insufficient conservative control on IOP, surgical solutions are needed. We describe a new, minimally invasive surgical procedure–the technique of the operation, the postoperative results and complications. Results: We present the achieved intraocular pressure (on the first day, 2 weeks, 1 month, 6, 8 12 and 18 months). The morphology of the trabecular area was demonstrated by gonioscopy. The effects of the therapy on the glaucoma progression, was evaluated with perimetry and OCT. Discussion: The following procedure is a minimally invasive procedure and provides good control of intraocular pressure. Aqueous veins in the conjunctiva are significantly preserved compared to conventional filtration trabeculectomy. This potentially modulates the physiological outflow pathways by ablating trabeculum strip the cause of increased outflow resistance-the inner wall of the SC. Conclusion: Removal of the inner wall of the SC, using Trabex+ (MST, Redmond, WA, USA), demonstrates promising results in the selected patients with a minimally invasive nature.

Update on Diagnosis and Treatment of Uveitic Glaucoma

“…TrabEx+ (MST, Redmond, WA, USA) consists of a handpiece with a dual blade that is also connected with an irrigation and aspiration system that adapts to each machine for phacoemulsification. Tanev et Kirkova reported 100% qualified success 18 months after performing TrabEx in 12 patients with UG [ 79 ].…”

Advanced Research in Glaucoma: Treatment and Postoperative Approaches

“…Furthermore, as the control of the IOP by IOP-lowering medications is hard to achieve in patients with uveitic glaucoma, these patients will sometimes require glaucoma surgery. It has been reported that there was a lowering of the IOP in post-uveitic patients with moderate glaucoma after undergoing removal of the internal wall of the Schlemm’s canal with the TrabEx+ device, or a minimally invasive surgical procedure [ 4 ]. For the phacoemulsification procedure, TrabEx+ utilizes a handpiece with an irrigation and aspiration system that can be adapted for each machine.…”

“…For the phacoemulsification procedure, TrabEx+ utilizes a handpiece with an irrigation and aspiration system that can be adapted for each machine. When using this procedure, there was a 20% or more reduction of the IOP from baseline in all of the patients observed during the follow-up period [ 4 ]. After glaucoma surgery, however, there is a great deal of concern with regard to corneal endothelial cell density (CECD) loss, especially when there is implantation of a glaucoma drainage device.…”