Ab Interno Approach To Surgical Treatment Of Different Types Of Glaucoma. 15 Years Of Experience.

To investigate the effectiveness of the ab interno approach in the surgical treatment of open-angle and angle-closure glaucoma

Recently, microinvasive glaucoma surgery has become the preferred method of treating glaucoma. In open-angle glaucoma, the most effective surgery is to improve outflow of intraocular fluid through the trabecular outflow pathways by removing trabecular tissue. In angle-closure glaucoma, the main goal of surgery is to open the anterior chamber angle.

There were 276 patients with open-angle glaucoma and 34 patients with angle-closure glaucoma under our observation. Only one eye of each patient was taken for analysis.

For patients with open-angle glaucoma, Endotrabeculectomy (ETE) – ab interno trabeculae ablation with the forceps after deepening of the chamber anterior with viscoelastics – was performed. ETE was combined with phacoemulsification (Phaco). For patients with angle-closure glaucoma, Goniosynechiolysis (GSL) was performed mechanically with the use of a spatula. The need for GSL was identified intraoperatively after Phaco. GSL was performed in cases when the anterior angle failed to open after Phaco and deepening of the anterior chamber with viscoelastics.

In the group of patients who underwent ETE+Phaco mean preoperative IOP was 21.6±2.2 mmHg, and the mean preoperative number of glaucoma medications was 2.6±0.8. 24 months after surgery, IOP decreased to 15.4±1.6 mmHg, and the number of glaucoma medications decreased to 1.1±0.7. 

In the group of patients who underwent Phaco+GSL, IOP decreased from 28.7±4.7 to 18.3±1.3 mmHg 24 months after the operation. Mean number of glaucoma medications decreased from 2.4±0.7 before operation to 1.1±0.7 24 months after operation. According to the results of OCT, after Phaco+GSL, the width of the ACA increased from 15.3±3.8° before operation to 29.1±2.9° 24 months after the operation. 

Ab interno approach to the anterior chamber angle is an effective minimally invasive surgical technique for both open-angle and angle-closure glaucoma. A combination of surgery with phacoemulsification may be recommended.