Dual Blade Goniotomy And Direct Viscodilation Of The Collector Channels With Cataract Surgery: 6 Year Results

The purpose is to evaluate a hybrid MIGS procedure using Goniotomy and Direct Viscodilation of the collector channels during 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.

This study was performed in a private practice that specializes in glaucoma and cataract. 

The dual blade removed 180° of trabecular meshwork after phacoemulsification. 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. Of the 394 total eyes 59% had severe to moderate glaucoma, 71% were African American, 51% were diabetic, 47% were on anticoagulants and 30% had previous glaucoma surgery.

Intial IOP was 19.3mmHg (SD±7.2) on 1.6 medications. Throughout the first year the IOP hovered around 16.0mmHg and stayed there until year 3 when it dipped to around 15.6mmHg (SD±4.0) and remained there throughout to year 6. Yr 1; 16% reduction in IOP, 77% reduction of drops. Yr. 2; 14.5% reduction in IOP, 69% reduction of drops. Yr 3; 17.6% reduction in IOP, 64% reduction in drops. Yr 4; 18.1% reduction in IOP, 72% reduction in drops. Yr 5; 18.1% reduction in IOP, 65% reduction in drops. Yr 6; 13.5% reduction in IOP, 87% reduction in drops.

The synergy of Goniotomy and Viscodilation markedly reduces IOP and medications even in advanced glaucoma thus improving compliance and reducing the associated financial burden. The Goniotomy-Viscodilation-Cataract technique addressess both trabecular outflow resistance and salvages the collapsed collector channels.