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Dual Blade Goniotomy and Direct Viscodilation of the Collector Channels with Cataract Surgery: 4 Year Results

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First Author: J.Gilmore USA

Co Author(s):    L. Burk MD   L. Gilmore                 

Abstract Details

Purpose:

The purpose is to evaluate a hybrid MIGS procedure using Goniotomy and Direct Viscodilation of the collector channels with cataract surgery in all levels of glaucoma. This unique technique called "clean the gutter and power wash the downspouts", not only removes the trabecular meshwork but also directly viscodilates the collector channels.

Setting:

The 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:

After cataract surgery, the Dual Blade removed 180° of trabecular meshwork. Viscoelastic was injected into the exposed ostium of the Collector Channels as the perpendicular viscoelastic cannula was held firmly against the outer wall and dragged through the gutted canal. Moderate to severe glaucoma comprised 64% of the 177 eyes followed at least 2 years. 32% had previous glaucoma surgery. 71% were African American. 44% were diabetics. 50% were on an anticoagulant.

Results:

Initial IOP was 18.5mmHg(SD+/-7.2)on 1.6 medications. At 3 months the IOP was 15.6mmHg(SD+/-5.1). Throughout the first year the IOP hovered around 16.5mmHg. IOP then settled to 15.5mmHg (SD+/-4.4)in 74 of the 177 eyes that were seen for 3 years. Although the IOP was reduced by 15%, 85-90% of the eyes had all drops stopped. All eyes had ≤15mmHg AND no meds in 71%(1yr), 59%(2 and 3yr), and 78%(4yr). The moderate to severe group had ≤15mmHg AND no meds 70%(1yr), 50%(2yr), 55%(3yr), and 75%(4yr). Medications were reduced by 1.5 to 1.0 drops per eye over the course of 4 years.

Conclusions:

The synergy of Goniotomy and Viscodilation markedly reduces drops even in advanced glaucoma with at least 50% of eyes achieving IOP ≤15mmHg,thus improving compliance and reducing the associated financial burden. The Goniotomy-Viscodilation-Cataract technique addresses both trabecular outflow resistance and salvages the collapsed collector channels.

Financial Disclosure:

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