Abstract
Purpose :
Although minimally invasive glaucoma surgery (MIGS) is becoming more common during routine cataract surgery in patients with primary open angle glaucoma, the majority of eligible patients do not undergo MIGS. While glaucoma surgeons routinely use a gonioprism for MIGS, comprehensive ophthalmologists may not be comfortable using a gonioprism. Small gauge endoscopes have been used for intraocular surgery for some time. Most commonly, intraocular endoscopy is used for laser ablation of the ciliary body. There are case reports of ophthalmic endoscopy used for lysis of anterior synechia and components of cataract surgery. Endoscopic visualization for angle based MIGS could increase adoption of combined MIGS with cataract surgery by comprehensive ophthalmologists.
Methods :
Six human cadaver eyes were inflated to physiologic pressure with saline and placed under an operating microscope. A paracentesis was created with a 15 degree blade. The anterior chamber was inflated with viscoelastic. A keratome was used to create a main entry wound. An ophthalmic endoscope was placed through the paracentesis and the anterior chamber angle was visualized and the trabecular meshwork was identified. A canaloplasty device was loaded with viscoelastic that had been stained with trypan blue. Canaloplasty was performed in the usual fashion using the canaloplasty device. The anterior chamber was reinflated with viscoelastic. A goniotomy was performed using a goniotomy blade.
Results :
Anterior chamber angle structures were identified endoscopically in all six eyes. Canaloplasty was successfully carried out endoscopically without the use of a gonioprism in all six eyes. The entry site of the canaloplasty was visualized endoscopically and the location was confirmed within the trabecular meshwork. Trypan blue was visualized in the canal of Schlemm endoscopically. Goniotomy was successfully performed with a goniotomy blade endoscopically in all six eyes.
Conclusions :
The feasibility of endoscopic assisted MIGS was demonstrated in human cadaver eyes. Endoscopic Assisted MIGS may be an alternative method in performing MIGS and should be further studied.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.