On October 1, 2004, the U.S Food and Drug Administration (FDA) approved a new surgical procedure for glaucoma that is faster, less invasive and safer than current surgical procedures.


The new procedure – called transciliary filtration (TCF) – reduced pressure inside the eye by creating a tiny opening, or micropore, in the sclera and underlying ciliary body to allowintraocular fluid to escape the eye and drain into the eye’s lymphatic system.


The micropore is created using a lightweight handheld device called a Fugo Blade (named after its inventor, Richard Fugo, MD, PhD).  The Fugo Blade generates a cloud of plasma particles around a tiny filament (about as thick as a human hair) at the end of the handpiece, and “cuts” tissue much as a laser beam does.  The device leaves a clean margin around the micropore, causing no damage to the surrounding tissue.


Advantages of TCF


According to Medisurg Ltd. (manufacturer of the Fugo Blade), transciliary filtration offers a number of advantages over traditional surgical procedures for glaucoma:

  • TCF is very quick.  (On average, it takes less than eight minutes to perform.)
  • It causes less tissue damage.
  • It has less risk of scarring and other complications.
  • If TCF is ineffective, it can be repeated.
  • It causes less bleeding during surgery.
  • TCF minimizes the need for post-operative care.


Effectiveness of TCF


Medisurg says nearly 1,000 transciliary filtration procedures have been performed worldwide.  On average, patients who have received the surgery had pre-operative intraocular pressure (IOP) between 30 and 44 mmHg.  Three months after TCF, IOP usually stabilizes at 14 to 15 mm Hg. 


(Internal eye pressure, or IOP, is measured in units of “millimeters of mercury” [mm Hg].  Normal IOP values are generally considered to be between 8 and 22 mm Hg.)


Eyedrop Medicines Still Treatment of First Choice


Though transciliary filtration appears to be safe and effective, the FDA currently advises surgeons to continue to prescribe eyedrop medication to lower IOP before resorting to surgical intervention for the treatment of glaucoma. 


But TCF offers surgeons an exciting new tool to treat glaucoma in patients whose IOP cannot be lowered sufficiently with eyedrop medicines alone.



(This article was adapted from a news report appearing in the November 2004 issue of Review of Ophthalmology.)

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