Trabectome Versus Canaloplasty Versus Trabeculectomy in Treating Glaucoma

February 26, 2009

Is trabectome just a fad? I think so. Fact is, we are doing glaucoma surgery on eyes that are really sick and need a pressure of around 12. Otherwise, the vast majority of our patients do pretty well with a combination of drops, laser and phaco. This trabectome won’t get pressures into the low teens.

I heard of another device that can be used during phaco that could drain aqueous intp the suprachoroidal space. Since no conjunctival manipulation is being done, you don’t “burn bridges” and can go to trab if you have to. If this is perfected, it sounds like a better deal.

Canaloplasty also sounds like a dead end. Have you seen the video?- that’s not easy surgery. And like trabectome, it won’t get pressures really low.

Looks like we’re stuck with trabs for now…




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2 Responses to “Trabectome Versus Canaloplasty Versus Trabeculectomy in Treating Glaucoma”

  • Dr. Ari Weitzner

    i defer to your experience and expertise!

  • Dr. Weitzner,

    I enjoy your posts, but I think you may be wrong about canaloplasty. While it is true that this surgery is technically challenging (read: it won’t be performed by every eye surgeon like cataract surgery and trabeculectomy), in experienced hands it is very effective. I have a number of patients s/p canaloplasty who have IOPs hovering in the range of 8-10mmHg off drops. Although that is not expected, neither is chronic hypotony, long-term bleb infection risk, or chronic dysesthesia.

    Hate to be selfish here, but with ODs now performing surgery we need more technically difficult (but therapeutically effective) surgeries to differentiate ourselves from anyone out there with the PAC funds to convince politicians that they can do eye surgery. I know there are very few surgeons comfortable with working so close to Descemet’s membrane. And, that’s a good thing.