Purchase this article with an account.
G. Baerveldt, R.S. Chuck, R.F. See, N. Rao, J. Gerg, R. Schauer; Novel Glaucoma Surgical Treatment-Goniectomy with Histology . Invest. Ophthalmol. Vis. Sci. 2003;44(13):1196.
Download citation file:
© ARVO (1962-2015); The Authors (2016-present)
Purpose: The major resistance to aqueous outflow lies in the trabecular meshwork. Goniectomy is an ab-interno surgical procedure, which utilizes a Swann-Jacob goniotomy lens. The goniectome, a new incisional and ablative device, is advanced across the anterior chamber through a 20g corneal incision. The goniectome contains an insulated footplate capable of penetrating the trabecular meshwork into Schlemm’s canal. An infusion and aspiration system combined with electrosurgery removes a 90° strip of the trabecular meshwork overlying Schlemm’s canal. Histology of the angle following this surgery is discussed. Methods: Human corneal rims preserved in Optisol were sectioned with a goniotomy knife incision and electrosurgical goniectomy and compared with unoperated control. Results: Control tissue demonstrates a well-preserved normal anatomy of the angle. Goniotomy demonstrates an incision through the trabecular meshwork into Schlemm’s canal. Electrosurgical goniectomy demonstrates the absence of a 75-100 µm strip of trabecular meshwork over Schlemm’s canal. Moreover both incisional borders of the trabecular meshwork displayed 25-50 µm of coagulative necrosis. Narrowing of the distance between Schwalbe’s line and the scleral spur occurs. Descemet’s membrane and the corneal endothelial cells appear intact. Conclusions: Electrosurgical goniectomy is able to remove a full thickness central strip of the trabecular meshwork overlying Schlemm’s canal with minimal collateral thermal damage.
This PDF is available to Subscribers Only