Abstract
Purpose :
The purpose was to evaluate Dual Blade goniotomy and direct viscodilation of the collector channels in eyes with previous peripheral iridotomies. Could the “clean the gutter and powerwash the downspout” technique be effective in opening the once aggravated trabecular meshwork?
Methods :
The Goniotomy-Viscodilation-Cataract Surgery group had twenty eyes with previous peripheral iridotomies. The Dual Blade removed 180 degrees of trabecular meshwork allowing access to the ostium of the collector channels for direct viscodilation. Eyes were monitored for steroid response, examined every 3 months, and treated with glaucoma medications as necessary.
Results :
Age ranged from 46 to 76 years. 50% were African-American. 70% were women. 30% had moderate or advanced glaucoma.
IOP started at 17.9mmHg (SD, 3.6) on 1.25 meds. At 1 month, the IOP was 16.7mmHg (SD,4.8) on 0.05 meds; at 3 months, 15.1 (SD, 4.2) on no meds; at 6 months,14.2mmHg (SD,3.5) on no meds; at 9 months, 16.8 mmHg (SD,3.4) on no meds; and at 12 months, 15.7mmHg(SD,4.8) on 0.18 meds. A blush of blood was common in the angle in the first week but resolved in a few weeks. Avascular fibrosis was seen over the trabecular meshwork in several eyes and was easily removed with the Dual Blade.
Although the IOP was only reduced by 12.2%, 92% of drops were eliminated and 90% of the patients were off all drops at one year.
Conclusions :
Narrow angle eyes with previous laser iridotomies can be successfully treated with the Goniotomy-Viscodilation-Cataract Surgery technique. This “clean the gutter and power wash the downspouts” approach demonstrates that the once aggravated trabecular meshwork can be cleaned, improving IOP control and reduction of glaucoma medications. This is a safe and effective treatment to reduce compliance issues and the financial burden of glaucoma medical therapy.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.