Abstract
Purpose :
The purpose was to evaluate Dual Blade Goniotomy and Direct Viscodilation of the collector channels in eyes with previous peripheral iridotomies for narrow angle glaucoma. Could the "clean the gutter and power wash the downspout" procedure effectively open the once aggravated trabecular meshwork?
Methods :
After standard cataract surgery, 32 eyes had 180 degrees of trabecular meshwork removed with the Kahook Dual Blade exposing the ostium of the collector channels allowing direct visco-dilation of the collector channels. Viscoelastic was injected into the collector channels as the cannula was snuggle held perpendicularly against the outer wall and dragged through the opened Schlemm's canal. Viscoelastic was used to break any anterior synechiae.
Results :
53% were African American. 72% were women. The average age was 68 years. 41% had moderate or advanced glaucoma. 51% were diabetics. 28% were on anticoagulants. Before surgery, the IOP was 22.4 mmHG (SD+/- 7.7) on 1.4 drops. At 3 months, the IOP was 15 mmHG (SD+/- 4/1) on 0.3 eye drops. IOPs were 16.1 mmHG (SD+/- 4.7) on 0.4 eye drops (1yr), 14.3mm HG (SD+/- 3.5) on 0.7 eye drops, and 14.7 mmHG (SD+/- 4.7) on 0.5 eye drops. Eye drops were eliminated in 74% (1yr), 53% (2yr), and 64% (3yr). A blush of blood was seen over the trabecular meshwork was common in the angle but was gone in two weeks. Avascular fibrosis was seen in several eyes and removed with the Dual Blade when the trabecular meshwork had been identified.
Conclusions :
Narrow angles previously treated with laser iridotomies can be successfully treated with the Goniotomy-Visco-dilation-Cataract Surgery technique. This "clean the gutter and powerwash the downspouts' approach demonstrates that the once aggravated trabecular meshwork can be rejuvenated, improving IOP control and reducing the amount of drops required.
This is a 2021 ARVO Annual Meeting abstract.