Endoscopy in Glaucoma Surgery
• Endoscopic Goniotomy
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Endoscopic Goniotomy With
Anterior Chamber Maintainer: Surgical Technique and One Year Results
Sükrü Bayraktar, MD
Taylan Koseoglu, MD
Endoscopic Goniotomy With Anterior Chamber Maintainer: Surgical Technique and One- Year Results Sükrü Bayraktar, MD Taylan Koseoglu, MD
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Endoscopic Goniotomy and Excimer Laser Trabeculotomy US Ophthalmic Review Spring 2012, pp: 33 - 36
Jens Funk MD, PhD Professor, Department of Ophthalmology, University Hospital Zurich
Marc Töteberg-Harms, MD Research Fellow, Massachusetts Eye and Ear Infirmary, Harvard Medical School,1,2
Peter P Ciechanowski, MD Resident, Department of Ophthalmology, UniversityHospital Zurich
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Endoscopic goniotomy lowers IOP in some primary congenital, developmental glaucoma casesJ Glaucoma. 2010;19(4):264-269. May 19, 2010 A small pilot study examining endoscopic goniotomy found that success was achieved after the procedure in less than half of children with opaque corneas and primary congenital glaucoma or developmental glaucoma. The retrospective review looked at 16 eyes of eight patients, four with primary congenital glaucoma, two with aniridia, one with Rubinstein-Taybi syndrome and one with neurofibromatosis. All patients underwent endoscopic goniotomy "for approximately 300° of the angle through temporal and superonasal corneal incisions." Mean age was 3.81 months."On average, [endoscopic goniotomy] lowered IOP by 16.7 mm Hg from preoperative baseline to the last follow-up visit in the 16 eyes, which constituted about 46% reduction from baseline IOP," the study authors said. Cases were consecutive, with an average follow-up of 18.8 months. The study's main outcome measurement was IOP change from baseline. Success was IOP of 21 mm Hg or less with or without medications and no further surgery. The study found that six eyes achieved success. Additional surgery was required in three patients. The most common complication was transient hyphema in eight eyes.
Endoscopic goniotomy lowers IOP in some primary congenital, developmental glaucoma cases J Glaucoma. 2010;19(4):264-269. May 19, 2010 A small pilot study examining endoscopic goniotomy found that success was achieved after the procedure in less than half of children with opaque corneas and primary congenital glaucoma or developmental glaucoma.
See Also Aphakic glaucoma possibly linked to IOP spikes after ... 360° trabeculotomy reduces IOP in select pediatric patients ... IOL implantation may be beneficial treatment for congenital ... "On average, [endoscopic goniotomy] lowered IOP by 16.7 mm Hg from preoperative baseline to the last follow-up visit in the 16 eyes, which constituted about 46% reduction from baseline IOP," the study authors said.
The retrospective review looked at 16 eyes of eight patients, four with primary congenital glaucoma, two with aniridia, one with Rubinstein-Taybi syndrome and one with neurofibromatosis. All patients underwent endoscopic goniotomy "for approximately 300° of the angle through temporal and superonasal corneal incisions." Mean age was 3.81 months.
Cases were consecutive, with an average follow-up of 18.8 months. The study's main outcome measurement was IOP change from baseline. Success was IOP of 21 mm Hg or less with or without medications and no further surgery.
The study found that six eyes achieved success. Additional surgery was required in three patients. The most common complication was transient hyphema in eight eyes.
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An Ocular Endoscope Enables a Goniotomy Despite a Cloudy Cornea
Karen M. Joos, MD, PhD; Jin H. Shen, PhD
Arch Ophthalmol. 2001;119(1):134-135. doi:.
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Endoscopic Goniotomy Overview
Surgical Technique The operation begins with a corneal stab incision made with a 20 g MVR knife in the inferotemporal quadrant. The anterior chamber maintainer cannula connected to an infusion bottle filled with BSS is inserted through this incision and the anterior chamber is deepened. The endoscope device (Endooptics®, Little Silver, NJ) com-posed of a control panel, console, video recorder, video monitor, and fiber optic probes measuring 19 and 20 Gauge. Three channels—diode laser beam, xenon light source beam, and a viewing fiber image bundle connected to a video cam-era and to the monitor—are integrated into these probes. A 20 Gauge probe is used for the goniotomy procedure because of its smaller diameter (external diameter measuring approximately 0.9 mm). A specially designed "Bayonet Blade" slides over the tip of the endoscope. The laser beam is not activated during the goniotomy procedure, only the lighting and viewing channels are used. In the double-port technique, the endoscope is introduced through the corneal stab incision made in the superior quadrant together with the special goniotomy knife mounted on it. Goniotomy of the inferior 120° circumference of the angle was done under endoscopic visualization. The goniotomy incision used in our technique was a superficial cut applied to the trabecular meshwork and the procedure proceeded because the drop of the iris root and a whitish band were clearly seen on the endoscope's screen. As soon as the inferior quadrant angle was incised, the ACM cannula and the endoscope probe (goniotomy knife mounted on it) were exchanged. The anterior chamber maintainer cannula was inserted through the 12 o'clock incision while the goniotomy knife integrated with the endoscope's probe through the inferotemporal incision and goniotomy of the nasal angle were done. Goniotomy of at least 240° circumference of the angle is typically done. During the operation, height of the infusion bottle is adjusted according to the anterior chamber depth, leakage through the incisions, and intraoperative hemorrhage. Pupils are constricted before surgery to prevent any potential damage to the crystalline lens and also at the end of the operation to keep the iris away from the goniotomy incision. The corneal incisions are sutured with 10-0 absorbable sutures at the end of the surgery. Postoperatively, broad spectrum antibiotics and corticosteroid eye drops are typically instilled at least 5 times daily for a week. They are continued and stopped according to a tapered regimen depending on the post- operative inflammation of the individual patient.
Endoscopic Goniotomy Overview
Surgical Technique
The operation begins with a corneal stab incision made with
a 20 Gauge MVR knife in the infero-temporal quadrant.
The anterior chamber maintainer cannula connected to an
infusion bottle filled with BSS is inserted through this incision and the
anterior chamber is deepened.
The endoscopy system (Endo Optiks®, Little Silver, NJ) is composed
of a control panel, console, video monitor, and 19 Gauge or 20 Gauge endoscopic
probes.
A 20 Gauge probe is used for the goniotomy procedure because
of its smaller diameter (external diameter measuring approximately 0.9
mm). A specially designed "Bayonet”
style Gonioblade slides over the tip of the endoscope.
The endoscope can be either a two function (Illumination and
Imaging) or three function (Illumination, Imaging and Laser) model, but the laser
beam is not activated during the goniotomy procedure.
In the double-port technique, the endoscope is introduced
through the corneal stab incision made in the superior quadrant together with
the special goniotomy knife mounted on it.
Goniotomy of the inferior 120° circumference of the angle
was done under endoscopic visualization. The goniotomy incision used in our
technique was a superficial cut applied to the trabecular meshwork and the
procedure proceeded because the drop of the iris root and a whitish band were
clearly seen on the endoscope's screen.
As soon as the inferior quadrant angle was incised, the ACM
cannula and the endoscope probe (goniotomy knife mounted on it) were exchanged.
The anterior chamber maintainer cannula
was inserted through the 12 o'clock incision while the goniotomy knife
integrated with the endoscope's probe through the infero-temporal incision and
goniotomy of the nasal angle were done.
Goniotomy of at least 240° circumference of the angle is
typically done. During the operation, height of the infusion bottle is adjusted
according to the anterior chamber depth, leakage through the incisions, and
intraoperative hemorrhage.
Pupils are constricted before surgery to prevent any potential
damage to the crystalline lens and also at the end of the operation to keep the
iris away from the goniotomy incision. The
corneal incisions are sutured with 10-0 absorbable sutures at the end of the
surgery.
Postoperatively, broad spectrum antibiotics and
corticosteroid eye drops are typically instilled at least 5 times daily for a
week. They are continued and stopped according to a tapered regimen depending
on the post- operative inflammation of the individual patient.
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