Abstract
Purpose :
Bent ab interno needle goniectomy (BANG) is a novel minimally invasive glaucoma procedure that has been developed to increase trabecular outflow. We performed this study to evaluate the reduction in intraocular pressure (IOP) and IOP lowering medication in primary open angle glaucoma (POAG) after bent ab interno needle goniectomy.
Methods :
We performed a retrospective chart review of 43 eyes of 33 patients who underwent the procedure with cataract surgery from 7/18/19 to 9/29/2020 in our outpatient surgical center. Mild, moderate, and severe glaucoma were included. 24 eyes were classified as POAG. Mean age was 70, 76% of patients Caucasian, and 42% of patients were male. Cataract extraction was performed prior to repositioning patient for direct gonioscopy. 25-gauge needle was bent at the tip to form a nearly 90 degree bend and attached to a viscoelastic cannula. A nasal goniotomy was created, which was then stripped for at least 30 degrees of trabecular meshwork. Reflex heme was noted. Irrigation/aspiration was used to remove reflex heme and viscoelastic prior to hydrating main wound and filling anterior chamber with adequate depth of pressure.
Results :
Average IOP reduction for all glaucoma patients at post op month 3 was 20.80% (P<0.0001). Average drop reduction was 0.88 (P=0.0009). The percentage of patients reaching IOP reductions of greater than 20% was 55.81%. When classified by type of glaucoma, POAG identified statistically significant decrease in IOP by 17.69% (P=0.0301) and drop reduction of 0.708 (P=0.0389). The percentage of patients reaching IOP reduction greater than 20% was 37.5%. When further stratified by severity of primary open angle glaucoma, the percent reduction was 25.893% (P=0.0118), 9.523% (P=0.5235), and 23.585% (P=0.1114) for mild, moderate, and severe POAG, respectively. The percentage of patients reaching IOP reductions of greater than 20% was 66.67%, 16.67%, and 50% in mild, moderate, and severe POAG, respectively.
Conclusions :
There is significant reduction across all severity of glaucoma, when classified by POAG, and further stratified by mild POAG. BANG procedure is an economical option, and when combined with cataract extraction, demonstrates greater than expected improvement in IOP. For phakic patients, cataract extraction/BANG may represent a viable first step instead of more conventional and invasive surgical intervention for glaucoma.
This is a 2021 ARVO Annual Meeting abstract.