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Abstract
PurposeTo compare intraoperative angle stability and postoperative outflow of two ab interno trabeculectomy devices that excise the trabecular meshwork with or without active aspiration and irrigation. We hypothesized that anterior segment optical coherence tomography (AS-OCT) allows for a quantitative comparison of intraoperative angle stability in a microincisional glaucoma surgery (MIGS) pig eye training model.MethodsTwelve freshly enucleated porcine eyes were measured with AS-OCT at baseline, at the beginning of the procedure and at its conclusion to determine the anterior chamber depth (ACD) and the nasal angle α in degrees. The right and left eye of pairs were randomly assigned to an active dual blade goniectome (aDBG) and a passive dual blade goniectome (pDBG) group, respectively. The aDBG had irrigation and aspiration ports while the pDBG required surgery under viscoelastic. We performed the procedures using our MIGS training system with a standard, motorized ophthalmic operating microscope. We estimated outflow by obtaining canalograms with fluorescent spheres.ResultsIn aDBG, the nasal angle remained wide open during the procedure at above 90° and did not change towards the end (100±10%, p = 0.9). In contrast, in pDBG, ACD decreased by 51±19% to 21% below baseline (p<0.01) while the angle progressively narrowed by 40±12% (p<0.001). Canalograms showed a similar extent of access to the outflow tract with the aDBG and the pDBG (p = 0.513). The average increase for the aDBG in the superonasal and inferonasal quadrants was between 27 to 31% and for the pDBG between 15 to 18%.ConclusionAS-OCT demonstrated that active irrigation and aspiration improved anterior chamber maintenance and ease of handling with the aDBG in this MIGS training model. The immediate postoperative outflow was equally good with both devices.
Highlights
A range of ab interno, angle based procedures have become available to remove or bypass the resistance to conventional outflow in open angle glaucomas [1,2]
In passive dual blade goniectome (pDBG), anterior chamber depth (ACD) decreased by 51±19% to 21% below baseline (p
Canalograms showed a similar extent of access to the outflow tract with the active dual blade goniectome (aDBG) and the pDBG (p = 0.513)
Summary
A range of ab interno, angle based procedures have become available to remove or bypass the resistance to conventional outflow in open angle glaucomas [1,2]. There is evidence that additional downstream elements exist [3], the trabecular meshwork (TM) is regarded as the principal pathology [4] The difference amongst such microincisional glaucoma surgeries (MIGS) is the method of TM removal and how the anterior chamber is maintained. The removal methods include an active, plasma-mediated TM ablation [5], physical TM excision without [6] and with irrigation and aspiration [7,8], respectively, as well as TM bypass stents [9,10]. The only system that maintained the anterior chamber actively with an irrigation and aspiration system was the Trabectome (Neomedix Inc.; Tustin, CA, United States), while the other surgical modalities used a viscoelastic device. Similar visualization challenges occur when viscoelastics are used with other TM excising MIGS that are made worse by a progressively shallowing anterior chamber and narrowing angle causing obscuration of the ablation target or billowing movements of the iris
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