Dual Blade Goniotomy And Direct Viscodilation Of The Collector Channels With Cataract Surgery: 6 Year Results
Published 2025 - 43rd Congress of the ESCRS
Reference: FP08.11 | Type: Free paper | DOI: 10.82333/v57s-s209
Authors: Jean carlos Morales* 1 , luis oviedo 2 , Sthefania Briceño 3 , Nadim El Maaz 1 , Jose Galue 1 , Humberto Ramirez 1
1oftalmologia ,Hospital Universitario de Maracaibo , Maracaibo ,Venezuela, Bolivarian Republic Of, 2oftalmologia,Hospital Universitario de Maracaibo ,maracaibo,Venezuela, Bolivarian Republic Of, 3oftalmologia ,Centro clinico de San Cristobal,San Cristóbal,Venezuela, Bolivarian Republic Of
Purpose
The purpose is to evaluate a hybrid MIGS procedure using Goniotomy and Direct Viscodilation of the collector channels wth cataract surgery in all levels of glaucoma. This technique called "clean the gutter and power wash the downspouts", not only removes the trabecular meshwork but also viscodilates the collector channels.
Setting
All surgery was performed by one surgeon (L.L.B) in a private clinical setting. Demographics comprised of 477 eyes followed at least 1 year. Moderate to severe glaucoma comprised 60%, 31% had previous glaucoma surgery, 66% were African American, 50% were diabetics, 48% were on anticoagulants.
Methods
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.
Results
Intial IOP was 19.2mmHg(SD±7.4) on 1.9 medications. At 1 yr the IOP was 16.6mmHg(SD±5.1). Throughout the first year the IOP hovered around 16.5mmHg. IOP then settled to 16.5mmHg(SD±4.8) in 80 of the 477 eyes that were seen in 6 years. Although the IOP was reduced by 15%, 50-70% of the eyes had all drops stopped. All eyes had ≤15mmHg AND NO MEDS in 39% (1yr), 27% (2-3yr), and 30% (yr 4-6). The moderate to severe group had ≤15mmHg AND NO MEDS 32% (1yr), 24%(2yr), 32%(3yr), 28%(4-6yr). Medications were reduced by 1.0 over the course of 6 years.
Conclusions
The synergy of Gonitomy 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.