Published date: Apr 29 2022

Journal Title: Journal of Ophthalmic and Vision Research

Issue title: April–June 2022, Volume 17, Issue 2

Pages: 170 – 175

DOI: 10.18502/jovr.v17i2.10787

Thomas ShuteshuteMD@gmail.comDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

Wesley GreenDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

James LiuDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

Arsham SheybaniDepartment of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, MO, USA

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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