Gonioscopic ab-interno trabeculectomy with vitreous cutter

Session Details

Session Title: Special Cases
Session Date/Time: Friday 26/02/2016 | 08:30-10:00
Paper Time: 08:36
Venue: MC3 Room
First Author: : A.Gavanescu ROMANIA
Co Author(s): :    R. Ionescu   A. Burloiu   A. Manolache        

Abstract Details

Purpose:

First Author: A. Gavanescu Romania Co. Authors: R. Ionescu A. Burloiu A. Manolache Purpose: Our paper evaluates the safety and the effectiveness of lower quadrants (90-270 degrees) ab-interno selective trabeculectomy using a 23 gauge vitreous cutter and a gonioscopic visualization system.

Setting:

Clinical Hospital “Nicolae Malaxa”, Bucharest and the Ophthalmology Department of the Emergency Hospital Targu-Jiu, Romania

Methods:

17 patients with Open Angle Glaucoma (OAG) with mean preoperative intraocular pressure (IOP) 24.7 mmHg were treated with ab-interno trabeculectomy using a 23 gauge vitreous cutter. Our study included 14 patients best medicated with 2 different types of glaucoma eye drops and 3 patients with a single type of glaucoma eye drops. Also, they were divided in 2 groups: 5 cases of cataract surgery with intraocular lens (IOL) implant and ab-interno trabeculectomy and 12 cases of ab-interno trabeculectomy only, on patients with clear lens. Postoperative outcomes included IOP, early complications and glaucoma medication through 5 months follow-up.

Results:

The mean pre-operative IOP in the lens extraction and ab-interno trabeculectomy group was 21.6 mmHg compared to 26 mmHg in the ab-interno trabeculectomy only group. The mean post-operative IOPs were: 13.5 mmHg (37.5% reduction) in the cataract surgery and ab-interno trabeculectomy group and 14.5 mmHg (44.24% reduction) in the ab-interno trabeculectomy only group. All patients no longer needed their anti-glaucoma medication through the 5 months follow-up. In all the cases blood reflux occurred from the collector channels during the procedure. There was one postoperative complication: hyphema which appeared at 2 patients and which disappeared within 8 to 10 days.

Conclusions:

Ab-interno trabeculectomy using the 23 gauge vitreous cutter on patients with OAG and with clear gonioscopic view of the angle is a promising procedure in substantial lowering the IOP during a 5 months follow-up period. Still, more case studies and longer follow-ups need to be done to validate long-term effectiveness of this technique.

Financial Interest:

NONE

Financial Disclosure:

NONE