Ab interno trabeculectomy (AIT) using the trabectome is a minimally invasive surgical technique for managing glaucoma by improving aqueous drainage and reducing intraocular pressure. The procedure requires only a small incision, preserving the conjunctiva, and features a favorable safety profile compared to traditional methods. Developed in the early 2000s, the trabectome has gained FDA clearance and is used for treating both adult and infantile glaucoma.

1. Presenting Author: Dr. Saudamini Jadhav
2nd year resident, MVPS Dr.Vasantrao Pawar Medical College, Nashik
Guide: Dr. Mrunal Patil
Professor & Dean, MVPS Dr.Vasantrao Pawar Medical College, Nashik
Co-Author: Dr. Dhiraj Balwir
Associate Professor, MVPS Dr.Vasantrao Pawar Medical College, Nashik

2. Introduction
 Ab interno trabeculectomy (AIT) with the trabectomeis an
electrosurgical procedure utilized in the management of
glaucoma.
 In the family of minimally invasive glaucoma surgeries
(MIGS), AIT decreases intraocular pressure (IOP) by
improving aqueous drainage through plasma-mediated
ablation and disintegration of the primary barrier to
outflow, the trabecular meshwork (TM).
 Unlike trabeculectomy, access to the TM and schlemm’s
canal (SC) with AIT is achieved through insertion of the
trabectome electrode tip through a small 1.6 mm clear-
corneal incision and, therefore, the conjunctiva remains
undisturbed and potential subsequent filtration surgery is
unaffected.

4.  Further, energy delivery by the trabectome device is
highly controlled with minimal heat dissipation to
contiguous tissues.
 These factors contribute to the generally favorable
safety profile of the procedure compared to more
traditional glaucoma surgeries.

5. History
 The trabectome device was invented by George Baerveldt
of the University of California – Irvine and Roy S. Chuck of
Montefiore Medical Center, with the associated patent
being filed in 2002.
 The commercial device is manufactured by the NeoMedix
Corporation (Tustin, CA) and is marketed for the
“microsurgical management of adult and infantile
glaucoma”.
 The device was cleared by the United States Food and Drug
Administration (FDA) in April 2004.
 Initial cases were performed in Mexico, with the first
procedures conducted in the US occurring in January 2006
for the treatment of open angle glaucoma

6. Mechanism
 The trabectome instrument utilizes a bipolar 550 kHz
electrode, with adjustable power, to enable plasma-
mediated ablation of the TM.
 Unlike cautery, plasma has a highly confined heat
dissipation cone with minimal thermal transfer to the outer
wall that is only about 1.2C. Plasma is the 4th state of
matter and causes tissue to disintegrate into its molecular
components, similar to ablative lasers.
 The device is equipped with a footplate that helps guide the
electrosurgical tip and protect adjacent tissues. Constant
infusion further helps to maintain the chamber and tissue
debris is removed by aspiration through the shaft of the
device.

8. Contraindications and Risk Factors
 neovascular glaucoma
 active uveitis
 elevated episcleral venous pressure
 angle dysgenesis
 corneal edema or other opacities causing a poor
gonioscopic view of the angle.