Sampling trabecular meshwork using TrabEx+

Ramjiani, Vipul; Mudhar, Hardeep-Singh; Julian, Thomas; Auger, Graham

doi:10.1186/s12886-021-01895-6

Cited by 8 publications

(14 citation statements)

References 11 publications

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“…This means the possibility of future bleb forming filtration surgery is not excluded. The dual-bladed device also allows in vivo samples of TM to be excised in a nondestructive manner, which may be of use in research applications 23…”

Section: Discussionmentioning

confidence: 99%

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

Gosling

Wang

Auger

2022

Journal of Glaucoma

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Précis: Irrigating goniectomy with the TrabEx+ device can lower intraocular pressure (IOP) in patients with glaucoma, as a standalone procedure or combined with cataract surgery. Purpose: The aim was to describe the efficacy and safety of irrigating goniectomy performed using the TrabEx+ device, either as a standalone procedure or combined with cataract surgery, in eyes with medically treated open-angle glaucoma. Methods: A retrospective case series of eyes treated by a single surgeon at a single UK teaching hospital. Data was collected at follow-up visits at 1 week, 3, 6, 12, 18, and 24 months postoperatively. Primary outcomes included IOP and glaucoma medication reduction after surgery. Proportion of eyes achieving >20% IOP reduction, IOP <21 mm Hg, and no reoperation were classified as surgical success. Results: Seventy-three consecutive eyes of 64 patients (mean age 68.4±13.7 y) were enrolled. 62% were treated as combined procedures with cataract surgery. Overall, mean IOP decreased from 31.3±7.3 to 20.9±10.4 mm Hg at the latest follow-up (34% reduction) (P<0.001) at the latest follow-up (16.1±10.3 mo) with mean preoperative medications decreased from 2.9±1.2 to 1.9±1.3 (P<0.001). 73% met the definition of success at latest follow-up. Postoperative complications were recorded including hyphaema (17%), uveitis (3%), hypotony (1%), and persistent vitreous hemorrhage (1%). Eighteen percent required reoperation because of treatment failure. Conclusion: TrabEx+ appears to be effective in lowering IOP and medication with or without cataract surgery. However, long-term safety and efficacy will be better understood in a prospective study with longer follow-up.

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Section: Discussionmentioning

confidence: 99%

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

Gosling

Wang

Auger

2022

Journal of Glaucoma

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“…We have developed a freeze-thaw protocol to decellularize anterior segments and to obtain a three-dimensional matrix to transplant modified trabecular meshwork (TM) cells or other cells under study 16,21 . This approach might generate ex vivo models for genetically altered, glaucomatous TM cells or primary cells harvested in excisional ab interno trabeculectomy [21][22][23] . Surprisingly, freeze-thawing did not alter the vascular drainage spaces qualitatively in a significant way.…”

Section: Discussionmentioning

confidence: 99%

Impact of freeze-thaw cytoablation on aqueous outflow patterns in ex vivo anterior chamber perfusion cultures and whole eyes

et al. 2022

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Background: Porcine eyes have been widely used as ex vivo models in glaucoma research, as they share similar features with human eyes. Freeze-thawing is a non-invasive technique that has been used to obliterate living cells in anterior segment ex vivo cultures, to prepare them for further research such as cellular repopulation. This technique has previously been shown to reduce the intraocular pressure (IOP) in porcine eyes. The aim of this study was to investigate whether freeze-thaw cytoablation causes corresponding canalogram outflow changes in perfused anterior segment cultures (AFT) and whole porcine eyes (WFT). We hypothesized that the known IOP drop in AFT after trabecular meshwork ablation by freeze-thaw would be accompanied by a similarly large change in the distal outflow pattern. Methods: Two-dye (fluorescein and Texas red) reperfusion canalograms were used to compare the outflow time before and after two -80°C cycles of freeze-thaw. We assigned 28 freshly enucleated porcine eyes to four groups: perfused anterior segment dye controls (ACO, n = 6), perfused whole eye dye controls (WCO, n = 6), freeze-thaw treated anterior segment cultures (AFT, n = 10), and freeze-thaw treated whole eyes (WFT, n = 6). Results: In control groups ACO and WCO, the two different dyes had similar filling times. In AFT, the outflow pattern and filling times were unchanged. In WFT, the temporal superior quadrant filled more slowly (p = 0.042) while all others remained unchanged. The qualitative appearance of distal outflow spaces was altered only in some eyes. Conclusions: Freeze-thaw cytoablation caused neither loss nor leakage of distal outflow structures. Surprisingly, the loss of an intact trabecular meshwork over the entire circumference did not result in a general acceleration of quadrant outflow times. The results validate freeze-thawing as a method to generate an extracellular matrix without major structural changes.

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“…Plasma-mediated ablation of the TM with the Trabectome (T; MicroSurgical Technology, Redmond, WA, USA), has been available to surgeons since 2004 [7], while excisional removal was first introduced in 2014 [8,9]. Interestingly, dual blade excision of tissue in the angle was invented earlier (1989), but was only used to obtain biopsies [10].…”

Section: Introductionmentioning

confidence: 99%

“…T enables the atraumatic molecularization and aspiration of the TM [7]. In contrast, TEx and KDB can be used to obtain TM samples [9] and excise the TM without the need to purchase a high-frequency alternating current generator as an additional, external device. An advantage of TEx over the KDB is the active irrigation and aspiration that improve visibility and anterior chamber stability [12].…”

Section: Introductionmentioning

confidence: 99%

“…A downside of both the TEx and KDB is that a dual cut of the TM cannot always reliably be initiated, potentially allowing remaining TM lips to reapproximate, as can happen in trabecular disruption by trabeculotomy [13]. Literature regarding TEx is limited to studies of its efficiency in obtaining TM biopsies in vivo [9] and ex vivo porcine anterior segments [2,12,14].…”

Section: Introductionmentioning

confidence: 99%

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Coarsened Exact Matching of Excisional to Plasma-Ablative Ab Interno Trabeculectomy

Dakroub¹,

Verma-Fuehring²,

Strzalkowska³

et al. 2021

Preprint

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Purpose: To compare ab interno trabeculectomy by trabecular meshwork excision to plasma-mediated ablation in primary open-angle glaucoma. Methods: Retrospectively collected data of TrabEx+ (TEx, n=56) and Trabectome (T, n=99) were compared by coarsened exact matching to reduce confounding and matched based on baseline IOP and age. Primary outcomes were IOP and number of glaucoma medications. Complications and need for additional glaucoma surgery were assessed. Patients were followed for up to one year. Results: 53 TEx could be matched to T. Baseline IOP was 16.5±4.6 mmHg in both; age was 73.7±8.8 and 71.5±9.9 years in TEx and T, respectively. TEx were taking more medications than T (p<0.001). IOP was reduced to 14.8±4.3 in TEx and to 13.4±3.4 in T at 6 months, and to 14.9±6.0 (p=0.13) in TEx and to 14.1±3.8 mmHg (all p<0.05) in T at 12 months. Medications were reduced at both 6 and 12 months (p< 0.05). No differences were seen between TEx and T at 6 and 12 months. In TEx, only one serious complication occurred, and two patients required further glaucoma surgery. Conclusion: Although both groups had a baseline IOP considered low for ab-interno trabeculectomy, IOP and medications were reduced further at 6 and 12 months. IOP reduction did not reach significance in TEx at 12 months. The inter-group comparison did not reveal any significant differences. Both had a low complication rate.

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Sampling trabecular meshwork using TrabEx+

Cited by 8 publications

References 11 publications

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

Early Results of Irrigating Goniectomy With TrabEx+: A Novel Device for the Treatment of Open-angle Glaucoma

Impact of freeze-thaw cytoablation on aqueous outflow patterns in ex vivo anterior chamber perfusion cultures and whole eyes

Coarsened Exact Matching of Excisional to Plasma-Ablative Ab Interno Trabeculectomy

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