This article is part of Ophthalmology Advisor’s conference coverage from the 2021 meeting of The Association for Research in Vision and Ophthalmology (ARVO), held virtually from May 1 to 7, 2021. The team at Ophthalmology Advisor will be reporting on a variety of the research presented by the eye and vision experts at ARVO. Check back for more from the ARVO 2021 Meeting.

 

An approach that uses dual blade goniotomy and direct viscodilation of the collector channels for narrow angle glaucoma can revive a once-aggravated trabecular meshwork, improving control of intraocular pressure (IOP) and reducing the number of drops required for treatment, according to a Dallas-based research team who presented their findings at the Association for Research in Vision and Ophthalmology (ARVO) 2021 annual meeting, held virtually from May 1 to May 7.


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The researchers nicknamed this approach “clean the gutter and power wash the downspouts” in their poster presentation. The study took into account 32 eyes of patients who had undergone standard cataract surgery and had 180 degrees of trabecular meshwork removed with the Kahook dual blade, exposing the ostium of the collector channels and allowing direct viscodilation of the collector channels. 

Viscoelastic was injected into the collector channels as the cannula was held against the outer wall and dragged through the opened Schlemm’s canal. Viscoelastic was used to break any anterior synechiae. 

The average age of the study’s participants was 68 years old, 53% of patients were Black, and 72% were women. Regarding health status, 41% of patients had moderate or advanced glaucoma, 51% had diabetes, and 28% were on anticoagulants. 

Before surgery, patients’ mean IOP was approximately 22.4 mm Hg and they used 1.4 drops. At 3 months following the procedure, the IOP was 15 mm Hg and they were using 0.3 eye drops. At 1 year, IOPs were 16.1 mm Hg and they were using 0.4 eye drops. Additionally, at 1 year, 74% of patients had ceased the use of eye drops altogether. Eye drop cessation was achieved in 53% at 2 years, and 64% at 3 years. 

A “blush” of blood over the trabecular meshwork was common in the angle but was gone in 2 weeks, according to the researchers. Avascular fibrosis was seen in several eyes and was removed with the dual blade when the trabecular meshwork had been identified.

Visit Ophthalmology Advisor’s conference section for complete coverage of the ARVO 2021 Meeting and more.

 

Reference

Burk L, Gilmore J.  Unique MIGS combining goniotomy and direct viscodilation of the collector channels in eyes with peripheral laser iridotomies. Poster presented at: Association for Research in Vision and Ophthalmology (ARVO); May 1-7, 2021; virtual. Abstract 3527419.