Viscocanalostomy (Visco360) and Trabeculotomy (Trab360)
Visco360/Trab360 are new minimally invasive surgical options for glaucoma. Minimally invasive glaucoma surgery is exciting because of its safety profile and fast post-operative recovery. Unlike other minimally invasive procedures for glaucoma, which only treat a small portion of the trabecular drainage system, the Trab360/Visco360 are new devices that treat the entire 360 degrees of trabecular meshwork. Visco360 is a procedure that dilates the entire 360 degrees of Schlemm’s canal, allowing the drainage channels to function better. There are no implants and there is minimal to no destruction of tissue. Visco360 can be repeated. It can be performed at the time of cataract surgery or as a stand-alone procedure.
A candidate for Visco360 would be a patient with mild-moderate glaucoma on multiple medicines with borderline high intraocular pressure. After surgery, the patient may be able to get off 1-2 drops and the vision on post-operative day 1 is usually very good.
Trab360 utilizes a similar approach, but instead of dilating the canal, it removes 360 degrees of trabecular meshwork, providing direct access for aqueous humor to Schlemm’s canal. Trab360 is an excellent option for patients with moderate-advanced glaucoma, since it is much safer than trabeculectomy and tube shunt surgery, and post-operative recovery is very fast. It can be performed as a stand alone or in conjunction with cataract surgery, but it can only be performed once.
A candidate for Trab360 would be a patient with moderate-advanced glaucoma on maximum tolerated medical therapy with high intraocular pressure. The procedure may bring eye pressure to adequate levels, lessen medication burden, and avoid more risky glaucoma surgeries.
Dr. Arkadiy Yadgarov is the first glaucoma specialist and surgeon in Georgia to start using both Trab360 and Visco360 by SightSciences.