Dr. Francis said that in his hands, the Trabectome is the easiest of the five procedures to perform, followed by the Kahook Dual Blade and Goniotome, which are similar in terms of ease. The Trab 360 comes next, and GATT is more difficult because it requires two incisions and involves threading the fiberoptic catheter (iTrack, Ellex) via one of the incisions into the canal.
Comparing the procedures with respect to risk of bleeding, Dr. Francis said the Trabectome is associated with the least amount of bleeding and is followed by the Kahook Dual Blade and Goniotome that are again about equal.
The risk of bleeding is greatest and similar for the two trabeculotomy procedures, he said.
In the absence of head-to-head comparative trials, it is not possible to make any definitive statements about relative efficacy for the unroofing procedures.
On average, they all lower IOP to 15 to 16 mm Hg and reduce daily glaucoma medication burden by one or two medications.
"Perhaps because the trabeculotomy procedures are treating 360° of the angle, they might have an edge in efficacy over the tissue removal procedures," he said.
Brian A. Francis, MD
E: [email protected]
This article was adapted from Dr. Francis' presentation given at the 2018 meeting of the American Glaucoma Society. He is a surgical trainer for NeoMedix.