University Hospitals introduces surgical procedure for management of glaucoma in NE Ohio

With the arrival of a leading expert in glaucoma, Douglas Rhee, MD, as its chairman of the Department of Ophthalmology and Visual Sciences, University Hospitals Case Medical Center is introducing a surgical procedure for the management of glaucoma that is new to Northeast Ohio.

The novel procedure is called a trabectome - a less invasive and less risky procedure - which could be an excellent alternative for select patients to the traditional surgery for glaucoma (called trabeculectomy).

Glaucoma is a condition in which the pressure inside the eye is too high for the optic nerve to withstand. "Think of it as the pressure pressing the optic nerve and causing irreversible damage. If left untreated, glaucoma can lead to blindness," said Dr. Rhee, who joined UH last fall from Harvard Medical School and Massachusetts Eye and Ear Infirmary.

Prescription eye drops and laser treatments are often the first lines of defense for managing glaucoma, a disease for which there is no cure. However, in 40 percent of the cases, these methods do not work and surgery is necessary.

In the traditional glaucoma surgery (trabeculectomy), eye surgeons create a passageway like a small tunnel that allows fluid to drain from the inside of the eye to the outside to relieve the pressure caused by glaucoma. The surgeons also make a tiny blister or bubble, called a bleb, near the drain of the eye (where the colored part meets the white part) to collect the fluid that comes out and allow the body to reabsorb it.

"Although it works, the issue with trabeculectomy is that the bleb makes it more prone to infection," said Dr. Rhee, who is also Chairman of the Department of Ophthalmology and Visual Sciences at Case Western Reserve University School of Medicine.

As a result, Dr. Rhee said eye surgeons have been looking for something better, and that led to the development of trabectome. Dr. Rhee has been involved with minimally invasive glaucoma surgery since its onset around 2005. While at Harvard, he was among a handful of surgeons in the nation to begin performing trabectome surgery.

Trabectome is different in that it doesn't create a full thickness passage through the eye.

"In other words, it doesn't create that tunnel all the way from the inside to the outside of the eye, thus it doesn't create that bleb. The main advantage of this procedure, aside from being less invasive, is that it's much safer and the long-term risks much lower," said

Dr. Rhee. "Additionally, the recovery period is shorter."

But it is not an alternative for all cases.

"For properly selected patients we can offer this and it can achieve a controlled pressure without engendering risks, inconveniences, or discomforts of a trabeculectomy," said Dr. Rhee. "Furthermore, if a trabectome fails to work, we haven't lost anything. A trabeculectomy can still be performed and have the same success profile as though the trabectome had never been done."

The first patient at University Hospitals Eye Institute to benefit from the trabectome was Lynette Hoehn, 67, of Sagamore Hills, Ohio, who has suffered from glaucoma for 14 years and cataracts for the past couple of years.

Medications were unable to control her eye pressure and she had had the traditional glaucoma surgery, trabeculectomy, in her right eye at another institution a few years ago. Her vision worsened due to the acceleration of cataract growth, which occurs in 80 to 85 percent of cases with trabeculectomy, so although her eye pressure was controlled in this eye, she couldn't see very well out of it because of the cataract.

Her left eye saw better, but her eye pressure was out of normal range because of glaucoma.

"I was nervous about doing my left eye first," said Hoehn. She allowed Dr. Rhee to do a cataract extraction on her right eye and replace her lens with a plastic, vision correcting lens.

"It worked so well that I said, let's do the other eye right away."

For the left eye, Dr. Rhee performed a trabectome, cataract extraction and lens replacement.

"For the first time in 30 years, I don't need to wear glasses," said Hoehn. "For the first couple of days, I couldn't believe it. Things were so clear.

"It's wonderful to be able to see."