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. 2022 Apr 29;17(2):170-175.
doi: 10.18502/jovr.v17i2.10787. eCollection 2022 Apr-Jun.

An Alternate Technique for Goniotomy: Description of Procedure and Preliminary Results

Affiliations

An Alternate Technique for Goniotomy: Description of Procedure and Preliminary Results

Thomas Shute et al. J Ophthalmic Vis Res. .

Abstract

Purpose: Multiple glaucoma treatment modalities seek to lower IOP by bypassing or removing a portion of the juxtacanalicular trabecular meshwork. These procedures often require expensive implants or specialized surgical instruments. The authors developed a technique for ab interno goniectomy utilizing a standard disposable 25-gauge hypodermic needle. The surgical procedure-termed bent ab interno needle goniectomy (BANG)-and preliminary results are presented here.

Methods: A retrospective chart review was performed for all patients who underwent goniotomy using a modified hypodermic needle by one of the three authors between July 2017 and June 2018. The mean and standard deviation pre- and postoperative IOP and the number of glaucoma medications were calculated. The student paired t-test was used to compare pre- and postoperative data. A P-value of < 0.05 was considered statistically significant.

Results: At postoperative month six, the mean IOP was 13.3 ± 2.5 mmHg (P = 3.6 × 10 - 7 ) on 0.5 ± 0.8 topical glaucoma medications (P = 0.01). A 20% reduction in IOP was achieved in 73% of patients. Seventy-three percent of patients required 1 fewer medication, while 73% of patients required no medications for IOP control. Forty-one percent of those treated achieved IOP 12 mmHg.

Conclusion: The BANG procedure is a low-cost MIGS technique available to surgeons around the world with preliminary outcomes similar to more expensive alternatives.

Keywords: Glaucoma; Goniotomy; Microinvasive Glaucoma Surgery.

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Conflict of interest statement

No author has financial interest in any material or method discussed.

Figures

Figure 1
Figure 1
Fashioning a goniotome from a 25-gauge needle using a needle driver.
Figure 2
Figure 2
Histologic specimen of human trabecular meshwork following excision with a modified 25-gauge hypodermic needle. Light micrograph, hematoxylin–eosin, 200 × magnification.

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