Trabectome: The Trabectome (NeoMedix) was the first pro¬cedure for MIGS ab interno trabecular ablation and got FDA approval in 2006. The trabectome is used to under gonioscopic guidance for a controlled electroablation of an arc of trabecular meshwork providing aqueous direct access to collector channels.
The device simultaneously aspirates the debris, resulting in less postoperative inflammation. It allows for a direct trans-trabecular channel to the collector channels from the anterior chamber. At the moment, iStent is designated for use simultaneously with cataract surgery. Although an off-label use, iStent has the ability to be titratable and can be implanted multiple times when one stent is unable to produce the desired outcome. The next generations iStent is currently pending FDA approval but is being assessed for use in conjunction to cataract surgery as well as a stand alone procedure. The iStent Inject has the unique ability to load two stents in the same procedure, inserted between several clock hours and has gained the safety and efficacy profile of the first generation iStent during trials.
The KDB is a surgical now with a sharp distal tip that pierces the TM, enters the Schlemm’s canal and helps faciliate goniotomy. As the instrument is advanced along the trajectory of Schlemm’s canal, the TM is elevated on the instrument’s ramp and guided onto 2 parallel blades. Unlike a standard goniotomy knife that simply incises the TM, leaving contiguous anterior and posterior flaps, the KDB excises a strip of TM, leaving a direct opening for aqueous to pass from the anterior chamber into Schlemm’s canal. Thus, the KDB procedure removes the tissue at the site of aqueous outflow obstruction in open-angle glaucoma, restoring the natural aqueous outflow pathway without the formation of a filtering bleb producing more sustained IOP control.The Xen Glaucoma Treatment System creates a subconjunctival drainage pathway to lower the IOP and received FDA approval in 2016. The implant is about 6 mm in length with an inner diameter of approximately 45 mm. It is comprised of a porcine gelatin hydrophilic tube cross-linked with glutaraldehyde.