Unique MIGS Combining Goniotomy and Direct Viscodilation of the Collector Channels in Eyes with Laser Peripheral Iridotomies. | ASCRS
Presentation
Unique MIGS Combining Goniotomy and Direct Viscodilation of the Collector Channels in Eyes with Laser Peripheral Iridotomies.
May 2020
Meeting: 2020 Virtual Annual Meeting
Session: SPS-105 Minimally Invasive Glaucoma Surgery: Viscocanalostomy, Combined Procedures, Outcomes
Authors: Linda L. Burk, MD, Jane Gilmore MD, MS
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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, 30 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 snuggly 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. 73% were women.The average age was 68 years. 50% had moderate or advanced glaucoma. 53% were diabetics. 30% were on anticoagulants. Before surgery, the IOP was 21.7 mm HG (SD+/- 7.5) on 1.7 drops. At 3 months, the IOP was 14.7 mm HG (SD +/-3.8) on 0.2 eye drops. This was consistent throughout the first year except for a spike 17.1 mm HG (SD=/- 4.9) at 9 months which decreased to 15.5 mm HG (SD =/- 4.5) on 0.2 meds at 12 months. 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.

Conclusion
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 cleaned, improving IOP control and reducing the amount of drops required.
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This presentation is from the session "SPS-105 Minimally Invasive Glaucoma Surgery: Viscocanalostomy, Combined Procedures, Outcomes" from the 2020 ASCRS Virtual Annual Meeting held on May 16-17, 2020.

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