Abstract
An 87-year-old woman with primary open-angle glaucoma presented to our hospital. Although the combined cataract and minimally invasive glaucoma surgeries (MIGS) were an appropriate surgical option, the presence of band keratopathy made it difficult to perform ab interno glaucoma surgery in her right eye (OD); therefore, the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. One month after chelation, microhook ab interno trabeculotomy and cataract surgery were performed successfully. Clear intraoperative visualization of the angle structures is critical for the success of these MIGS procedures. In glaucomatous eyes that require MIGS, EDTA chelation is a good neoadjuvant therapy for coexisting band keratopathy.
Highlights
Ab interno approach is used in new minimally invasive glaucoma surgery (MIGS) procedures including the Trabectome (NeoMedix Corporation, Tustin, CA), Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA), microhook ab interno trabeculotomy, and 360-degree suture trabeculotomy, instead of the ab externo approach as in conventional trabeculotomy [1]
An 87-year-old woman with primary open-angle glaucoma presented to our hospital
Clear intraoperative visualization of the angle structures is critical for the success of these minimally invasive glaucoma surgeries (MIGS) procedures
Summary
Ab interno approach is used in new minimally invasive glaucoma surgery (MIGS) procedures including the Trabectome (NeoMedix Corporation, Tustin, CA), Kahook Dual Blade (New World Medical, Rancho Cucamonga, CA), microhook ab interno trabeculotomy, and 360-degree suture trabeculotomy, instead of the ab externo approach as in conventional trabeculotomy [1]. The combined cataract and minimally invasive glaucoma surgeries (MIGS) was an appropriate surgical option, the presence of band keratopathy (Figure 1(a)) made it difficult to perform ab interno glaucoma surgery OD; the corneal opacity was removed using ethylenediaminetetraacetic acid (EDTA) chelation procedure. Microhook ab interno trabeculotomy and cataract surgery [3] [4] were performed (Figure 1(b)). Under visualization using a Swan-Jacob gonioprism lens (Ocular Instruments, Bellevue, WA), the inner wall of Schlemm’s canal and trabecular meshwork were incised over 3 clock hours nasally (Figure 1(c)) and temporally (Figure 1(d)) using Tanito ab interno trabeculotomy microhooks (Inami) inserted through the corneal side ports. Postoperatively, the BCVA and IOP were 0.7 and 10 mmHg, respectively, with use of three antiglaucoma medications OD
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