Direct Viscodilation Of Collector Channels After Goniotomy With Cataract Surgery: 5Yr Results

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 not only removes the trabecular meshwork but also directly viscodilates the collector channels. 

This long term study combines Goniotomy and direct visualization of the visco-dilation of the collector channels. The study took place in a clinical setting over the course of 5 years. Most MIGS study have been done primarily in Caucasion patients.  Moderate to severe glaucoma comprised 58% of the 213 eyes followed at least 2 years. 32% had previous glaucoma surgery. 71% were African American. 44% were diabetics. 50% were on an anticoagulant.

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 58% of the 213 eyes followed at least 2 years. 32% had previous glaucoma surgery. 71% were African American. 44% were diabetics. 50% were on an anticoagulant.

Intial IOP was 19.0mmHg(SD±7.1)on 1.7 medications. At 3 months the IOP was 15.5mmHg(SD±5.0). Throughout the first year the IOP hovered around 16.0mmHg in 316 eyes. IOP then settled to 16.2mmHg(SD±6.1) at 3 years(n=120) and 16(SD±4.1) at 4 years(n=63). Although the IOP was reduced by 15%, the reduction in medications hovered around 70% over 5 years. All eyes had ≤15mmHg AND no meds in 37%(1yr), 30%(2yr), 37%(3yr), and 32%(4yr). Even the moderate to severe group had ≤15mmHg AND no meds 38%(1yr), 30%(2yr), 36%(3yr), and 32%(4yr). Medications were reduced by 1.5 drops per eye over the course of 5 years. Reduction of drops in this group of 316 eyes resulted in a savings of $240,000 in the first year alone.

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.