Glokom Cerrahisinde Minimal İnvaziv Bir Prosedür: Trabektom

Son yıllarda yeni tekniklerin ve implantların geliştirilmesi ile geleneksel glokom cerrahilerinin gerekliliği sorgulanmaya başlanmıştır. Bu yeni yöntemler ve implantlar, penetran cerrahilere göre daha yüksek güvenlik profili ile göz içi basıncını (GİB) düşürmeyi amaçlayan prosedürler olup genel olarak “Mikroinvaziv veya Minimal İnvaziv Glokom Cerrahi (MİGC)” yöntemleri olarak adlandırılmaktadır. MİGC yöntemlerden birisi olan trabektom ile yapılan ab interno trabekülektomi, trabeküler ağ ve Schlemm kanalı iç duvarını selektif olarak uzaklaştırarak, fizyolojik akımı arttırıp GİB’i azaltmayı amaç- layan yeni bir glokom cerrahisi prosedürüdür. Trabektom cerrahisi, postoperatif GİB’de orta seviyelerde düşüş hedeflenen, medikal tedavinin yetersiz olduğu veya tolere edilemediği farklı tip açık açılı glokom hastaları için iyi bir alternatif cerrahi yaklaşım olarak görülmektedir. Bununla birlikte, daha invaziv cerrahi yöntemlerin endike olduğu fakat glokomatöz hasarı az veya hiç olmayan hastalar için başlangıç cerrahi yaklaşım olabileceği gibi penetran cerrahilerin uygun olmadığı hastalar için de iyi bir seçenek olabilir. Bu makalede ab interno yaklaşımla uygulanan yeni bir MİGC yöntemi olan trabektom elektrokoter cihazı ile yapılan araştırmalar ele alınmıştır.

A Minimally İnvasive Procedure in Glaucoma Surgery: Trabectome

Traditional glaucoma surgery procedures has been challenged by the advent of innovative techniques and new implants in recent years. This new procedures and devices aim to lower intraocular pressure (IOP) with a higher safety profile than penetrating procedures and are collectively termed “Micro-invasive or Minimally Invasive Glaucoma Surgery (MIGS)”. Ab interno trabeculectomy surgery performed with trabectome is one of the new MIGS methods which increases physiological outflow and reduces IOP by removing trabecular meshwork and the inner wall of Schlemm’s canal selectively. Trabectome surgery is considered as a good alternative surgical approach for patients who do not respond or do not tolerate to medication and aiming moderate reduction in intraocular pressure with different types of open angle glaucoma patients. However, trabectome surgery could be an initial surgical approach for patients who indicated for more invasive surgery but have no or little glaucomatous damage and also become an good option for patients who are not appropriate for penetrating surgery procedures. This article reviews the trials related to trabectome electrocautery device that is one of the new techniques of MIGS performed by ab interno approach.

Kaynakça

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