Intraoperative optical coherence tomography and ab interno trabecular meshwork surgery with the Trabectome

Area of Science:

• Ophthalmology
• Glaucoma Surgery
• Medical Imaging

Background:

• Trabecular meshwork surgery aims to reduce intraocular pressure in glaucoma.
• Assessing surgical success, particularly the removal of trabecular meshwork, is crucial.
• Intraoperative visualization aids in confirming the immediate outcomes of surgical procedures.

Purpose of the Study:

• To evaluate the utility of intraoperative optical coherence tomography (iOCT) for visualizing trabecular meshwork removal during Trabectome surgery.
• To assess the immediate success of ab interno trabeculotomy using iOCT in a clinical setting.
• To determine the effectiveness of iOCT in visualizing the anterior chamber angle before and after the procedure.

Main Methods:

• A retrospective clinical study involving nine patients with open-angle, pigment dispersion, or pseudoexfoliation glaucoma.
• Ab interno trabeculotomy was performed using the Trabectome, with iOCT used for visualization.
• Visualization of the anterior chamber angle was attempted with and without a modified Swan-Jacobs lens.

Main Results:

• Visualization of the anterior chamber angle and post-trabecular meshwork removal wound gap was achieved in all nine patients when using a modified Swan-Jacobs lens.
• Without the lens, visualization was successful in only two out of five cases.
• iOCT confirmed the removal of trabecular meshwork, indicating immediate surgical success.

Conclusions:

• Intraoperative optical coherence tomography (iOCT) is effective in objectifying the immediate success of trabecular meshwork removal during Trabectome surgery.
• The use of a modified Swan-Jacobs lens significantly enhances iOCT visualization of the anterior chamber angle and surgical outcomes.
• While iOCT confirms the removal of tissue, it does not capture the entire surgical procedure itself sufficiently.