Dual Blade goniotomy and direct viscodilation of the collector channels combined with cataract surgery in eyes with previous laser peripheral iridotomies

Session Details

Session Title: Presented Poster Session: Combined Cataract Surgery & Cataract Surgery Complications

Venue: Poster Village: Pod 1

First Author: : L.Burk USA

Co Author(s): :    J. Gilmore   L. Gilmore                    

Abstract Details

Purpose:

The  Goniotomy-Viscodilation-Cataract Surgery technique was evaluated in eyes with previous laser peripheral iridotomies for reduction of IOP and eye drops.  Could the once aggravated trabecular meshwork be effectively opened with “clean the gutter and power wash the downspout” approach?

Setting:

This report is a retrospective study of glaucoma patients who presented for cataract surgery in a private practice.  All surgery was performed by one surgeon. (L.L.B)

Methods:

Thirty eyes had 180 degrees of trabecular meshwork removed with the Kahook Dual Blade exposing the ostium of the collector channels allowing direct viscodilation of the collector channels.  Viscoelastic was injected into the collector channels as the cannula was perpendicularly dragged along the outside wall of the gutted canal.

Results:

50% had moderate to advanced glaucoma.The average age was 68 years.  53% were African American. 53% were diabetics. 30% were on anticoagulants.  Initial IOP was 21.7 mmHG (SD+/- 7.5) on 1.7 drops.  At 3 months, the IOP was 14.7 mm HG(SD+/- 3.8) on 0.2 drops. A spike was seen at 9 months to 17.1mm HG (SD+/- 4.9) on 0.2 drops, which decreased to 15.5 mmHG (SD+/- 4.5 ) on 0.2 drops at 12 months.  Avascular fibrosis  over the trabecular meshwork was seen in several eyes which was easily removed with viscoelastic dissection and the Dual Blade.

Conclusions:

Narrow angles eyes with previous iridotomies can be successfully opened with the Goniotomy-Viscodilation-Cataract Surgery approach leading to the  reduction of IOP and elimination of eye drops. This “clean the gutter and power wash the downspouts” approach demonstrates that the once aggravated trabecular meshwork can be cleaned and rehabilitated.  This is an effective treatment to reduce compliance issues and the financial burden of glaucoma therapy.

Financial Disclosure:

None