Trabecular aspiration: a new surgical approach to improve trabecular facility in pseudoexfoliation glaucoma

The main reason for elevation of intraocular pressure in pseudoexfoliation glaucoma is due to secondary plugging of the intertrabecular spaces by pigment and fibrillous material. The aim of the present study was to introduce a new surgical concept to clean trabecular meshwork in pseudoexfoliative glaucoma. 'Trabecular aspiration' was performed under the operating microscope prior to extracapsular cataract extraction in half of the chamber angle circumference using a specially designed irrigation-aspiration device. The hand-held instrument has three outlets, one for aspiration (400 microns wide and 45 degrees horizontally angulated to meet the slope of the meshwork) and two openings (650 microns) for irrigation to maintain a deep anterior chamber and to keep the iris away from suction. Trabecular debris and pigment was cleared with a suction force of 100-200 mmHg. The effect of trabecular aspiration was cross-checked by analysing the aspirate. Pigment granules, fibrillous protein and other forms of trabecular debris were identified in the aspirate using light- and scanning electron microscopy. The morphological analysis of the trabecular aspirate clearly indicates the efficacy of 'trabecular aspiration' for removing pre- and intratrabecular debris. The clinical relevance of this new procedure looks promising, a clinical trial, recently initiated, is warranted.