to the opening to fill
the canal with vis-
coelastic. The iTrack
device from Ellex
includes a lighted tip
so that you can see
your progress. This
can also be done
with a device called
VISCO360 from
SightSciences. The
iTrack was designed
for ab externo use and was not originally indicated for ab interno, but
has been effectively used in an ab interno fashion for a few years now.
The VISCO360 is on label for an ab interno indication and was
designed from its inception as such.
Another approach is to unroof the canal by removing part or all of
the trabecular meshwork that covers it. This can be done with a
suture, or more reliably with the iTrack catheter mentioned above or
another device from Sight Sciences called the TRAB360. These
devices remove the entire 360 degrees of canal, lowering IOP by
about 2-3 mmHg more than if you only remove part of the meshwork.
However, removing only part of the meshwork is also effective. Two
techniques that partially remove the trabecular meshwork include the
Kahook Dual Blade (New World Medical) and the Trabectome device
(Neomedix). The latter has the disadvantage of a large capital cost.
However, the device offers the distinct advantage of being able to
inject and aspirate saline to maintain the anterior chamber. Finally,
the FDA has just approved a new device from SightSciences called
the OMNI system that essentially does both VISCO360 and TRAB360
M a r c h 2 0 1 7 • O U T PA T I E N T S U R G E R Y. N E T • 5 3
• THE NONINVASIVE GPROBE destroys the ciliary processes with laser energy,
reducing aqueous production.
