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 with 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.

All surgery was performed by one surgeon (L.L.B) in a private clinical setting. Demographics comprised of 456 eyes followed at least 1 year. Moderate to severe glaucoma was 56%, 28% had previous glaucoma surgery, 66% were African American, 11.3% were Hispanic, 22% Caucasion, 0.7% Other, 49% were diabetics and 46% were on anticoagulants.  

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.

Initial IOP was 19.4mmHg(SD± 7.3) on 1.6 medications. Throughout the first 4 years the IOP hovered around 16.5mmHg(SD± 5.4). IOP then settled to 15.7mmHg(SD± 4.1) in 100 of 456 eyes at 5 years. Although IOP was reduced by 15%, 60-70% were on no medications. Medications were reduced 1.5 to 1.0 drops per eye over the course of 6 years. Reduction in the number of drops was 73%(1yr), 65%(2,3yr), 60%(4,5yr) and 50% (6yr). 30% of all eyes (including moderate to advanced glaucoma) ≤ 15mmHg on no medications.  Estimating just the patient cost ($50/bottle/month; $600/yr), the reduction of 600 bottles/month for all eyes in the first year is $30,000/month or $360,000/year.

The synergy of Goniotomy and Viscodilation markedly reduces drops even in advanced glaucoma with at least 30% of all eyes achieving IOP ≤15mmHg. If 60-70% of patients are on no drops this would result in 100% compliance in that group.  This technique not only improves compliance but also reduces the associated financial burden ($360,000/yr). The Goniotomy-Viscodilation-Cataract technique addresses both trabecular outflow resistance and salvages the collapsed collector channels.