Trabeculotomy

1,099 views

Published on

surgery for congenital glaucoma

Published in: Health & Medicine, Sports
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,099
On SlideShare
0
From Embeds
0
Number of Embeds
5
Actions
Shares
0
Downloads
57
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Trabeculotomy

  1. 1. Trabeculotomy
  2. 2. • Recommended originally as surgical treatment for both primary infantile glaucoma and primary open-angle glaucoma.
  3. 3. Indication Primary infantile glaucoma • when angle structures cannot be visualized through a cloudy cornea. • After the failure of two goniotomies. Juvenile open-angle glaucoma
  4. 4. • Long-term results are impressive in managing infantile glaucoma and open-angle glaucoma in younger adults. • Trabeculotomy has a high success rate (80– 90%). • less useful in older patients with chronic open-angle glaucoma unless there are angle changes compatible with juvenile anomalies.
  5. 5. procedure
  6. 6. • High magnification • Depper scleral dissection.
  7. 7. • canal is found in the corneoscleral sulcus at the blue-grey/white transition between scleral and corneal tissue. • Using high magnification (16x to 25x), • cellulose sponge can dry the junction and allow for the appreciation of droplets of clear aqueous beading precisely above the canal. • A radial incision 2 mm in length is made at that point. • As the canal is approached, there is a seeping of aqueous and often a tinge of blood as the outer wall of the canal is cut
  8. 8. To ensure the accuracy of the incision  3 cm of 5-0 or 6-0 monofilament (e.g., Prolene or nylon) suture with a beveled tip.  Entered 5 mm.  suture should enter easily and slide into the eye following the course of the canal.  not be possible to rotate the suture anteriorly into either the anterior chamber or posteriorly into the suprachoroidal space.  The suture may be viewed gonioscopically to be sure of its proper positioning.
  9. 9. ICath • catheter with an LED on the end which allows visualization of the catheter as it transits the 360° of Schlemm’ canal.
  10. 10. Harms or McPherson trabeculotome • Probe centripetely rotated. • Parallel to iris plane. • If more ANT – desment tear. • If more POST- lens demage.
  11. 11. Purse-string 360° trabeculotomy • reported to have an excellent ‘success’ rate for pressure control comparable to or better than goniotomy and trabeculotomy with metal trabeculotomes. • One complication of this procedure is that the Prolene suture or the catheter can be misdirected into either the anterior chamber or, more ominously, into the suprachoroidal space. • can also be done with the Icath.
  12. 12. Combined trabeculotomy and trabeculectomy • long-term outcome of mitomycin-C trabeculectomies was similar to that of Ahmed valve implants. • complications were greater for the trabeculectomy group, • whereas the Ahmed group was morelikely to need subsequent medications to control the pressure.
  13. 13. Trabeculodialysis Glaucoma secondary to juvenile rheumatoid arthritis (Still’s disease)
  14. 14. Thnak you

×