Trabectome Glaucoma Surgery: Uses, Limits and Risks
Trabectome is a device used for ab interno trabeculotomy, an angle-based glaucoma operation that removes a strip of trabecular meshwork to improve aqueous-humour access to the eye’s natural drainage channels. It may lower intraocular pressure in selected open-angle glaucoma, but it does not restore optic-nerve damage or guarantee that medicines can be stopped.
Key Points
- The procedure requires an accessible drainage angle and is not suitable for every glaucoma type.
- It can be performed alone or during cataract surgery, but the two operations have separate purposes and risks.
- Pressure reduction may be insufficient or temporary, and drops or further surgery may still be needed.
- Bleeding into the front of the eye is expected in some cases; pressure spikes and serious complications can occur.
- Glaucoma monitoring remains necessary even when pressure improves.
How the Drainage Angle Works
Aqueous humour normally leaves the eye through the trabecular meshwork, Schlemm’s canal and collector channels. In open-angle glaucoma, resistance in this pathway can contribute to pressure that damages a susceptible optic nerve.
Trabectome applies electrosurgical energy and aspiration to remove part of the trabecular meshwork from inside the eye. It depends on the remaining downstream drainage system, so the achievable pressure is limited by that anatomy.
Who May Be Considered
An ophthalmologist may consider angle surgery for selected open-angle glaucoma when a moderate pressure reduction or reduction in treatment burden is appropriate. The decision considers current pressure, target pressure, optic-nerve damage, visual field, medicines, prior laser or surgery, lens status and angle anatomy.
Angle closure, poor view of the angle, extensive scarring or a pressure target unlikely to be reached by this pathway may make another treatment more appropriate. Advanced glaucoma does not automatically rule the procedure in or out, but the consequences of inadequate control are greater.
Assessment Before Surgery
Assessment can include vision, refraction, pressure measurements, corneal thickness, gonioscopy, optic-nerve and retinal examination, visual fields and imaging. The clinician should confirm the glaucoma type and progression and explain the individual target pressure.
Review all medicines, allergies, bleeding history and anaesthetic issues. Do not stop anticoagulants, antiplatelet medicines or glaucoma drops unless the responsible prescriber and surgeon give specific instructions.
What Happens During the Procedure
Through a corneal incision, the surgeon uses a gonioscopic view to position the handpiece in the drainage angle and remove a planned segment of trabecular meshwork. Anaesthesia and the amount treated depend on the eye and clinical plan.
The term minimally invasive describes the surgical access, not an absence of internal-eye risk. The operation can be technically limited by visibility, anatomy, bleeding or device access.
Combining It With Cataract Surgery
Trabectome may be performed during cataract surgery when both conditions warrant treatment. Cataract removal can itself affect pressure, which makes comparisons between combined and standalone results difficult.
Combined surgery adds cataract-specific risks, lens calculations and visual trade-offs. It should not be offered solely because combining procedures is convenient; each component needs a documented indication and consent.
Expected Results and Limitations
The intended benefits are lower pressure, fewer medicines or both. None is assured. Results vary with glaucoma type, baseline pressure, angle anatomy, previous treatment, combined cataract surgery and how success is defined.
The operation does not reverse lost visual field and cannot guarantee prevention of progression. A pressure that is statistically lower may still be above the target for a particular optic nerve. Published percentages should not be used as a personal prediction.
Risks and Complications
Potential complications include blood in the anterior chamber, pain, inflammation, pressure spike, pressure that remains too high, low pressure, corneal injury, infection, cataract progression, peripheral anterior synechiae and need for further treatment.
Serious loss of vision is uncommon but possible with intraocular surgery. Additional drops, drainage-angle treatment, trabeculectomy, a drainage implant or another operation may be needed if control is inadequate.
Aftercare and Follow-up
Postoperative drops and continuation of glaucoma medicines are individual. Do not stop pressure-lowering treatment because the operation has been completed; the ophthalmologist should change medicines after examining the eye and measuring pressure.
Follow-up checks pressure, inflammation, cornea, wound, optic nerve and visual function. Seek urgent eye care for severe or increasing pain, sudden or worsening vision, marked redness, discharge, nausea with eye pain, or a new curtain, shadow, flashes or floaters.
Comparing Glaucoma Operations
Angle surgery generally aims for a different balance of pressure reduction and risk from trabeculectomy or drainage-implant surgery. A procedure with a smaller incision is not automatically the right choice when a very low target pressure is required.
Ask what alternatives are appropriate, why Trabectome is expected to meet the target, what counts as failure and which next operation would be offered. Device novelty or surgeon preference should not replace this comparison.
Planning Care Through Revitalize
Confirm the ophthalmologist’s full name, registration and current glaucoma-surgery experience, the contracted facility, exact device, treatment goal, combined procedures and emergency pathway. The surgeon should review the gonioscopy and progression evidence.
Revitalize support can help obtain a named-clinician assessment and itemised plan. Remote enquiries cannot establish glaucoma type, angle anatomy or target pressure.
Independent Patient Information
Frequently Asked Questions
Will Trabectome restore vision lost from glaucoma?
No. Its purpose is pressure control, not recovery of optic-nerve damage.
Can I stop glaucoma drops after surgery?
Only when the treating ophthalmologist changes them after pressure and eye checks.
Is it always safer than trabeculectomy?
No. The procedures have different pressure-lowering potential, risks and indications.