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Microincision trabeculectomy may set new standards in glaucoma surgery

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ROME — Similar to cataract surgery, microincisions should be a goal in trabeculectomy and can be achieved by using a special technique and special instruments, according to a surgeon here.

"Failure of filtration is often due to scarring of the incision. I designed a micro-punch, currently produced by Katena, that can be introduced through an incision as small as 1 mm and, with a pinching action, removes a few bites of the trabecular meshwork to open the way to the flow," Hideharu Fukasaku, MD, said at the annual joint meeting of Ocular Surgery News and the Italian Society of Ophthalmology.

The Fukasaku micro-punch reaches the trabeculum through a an oblique scleral tunnel, previously created with a 19-gauge knife. Peripheral iridectomy can be performed using a 20-gauge vitrector.

In 29 cases of microincision trabeculectomy, a postop IOP of 8 mm Hg to 12 mm Hg was achieved and was stable at 12 months without medications.

"This technique is fast, nontraumatic and safe, and has long-lasting good results. It will set new standards for glaucoma surgery," Dr. Fukasaku said.