Goniocurettage for removing trabecular meshwork: clinical results of a new surgical technique in advanced chronic open-angle glaucoma

Abstract

PURPOSE: To elucidate the long-term outcome of goniocurettage as a new technique in trabecular microsurgery for advanced open-angle glaucoma. METHODS: In a prospective, nonrandomized clinical trial, 25 eyes of 25 patients with a mean age ± SD of 72.7 ± 10.1 years (range, 50 to 89 years) with uncontrolled chronic open-angle glaucoma that had undergone failed filtering procedures were treated by goniocurettage. Trabecular tissue was scraped away from the chamber angle by means of an instrument similar to a microchalazion curette (diameter, 300 μm). RESULTS: Before surgery, intraocular pressure ranged from 29 to 48 mm Hg (mean ± SD, 34.7 ± 7.1 mm Hg), and mean number of antiglaucoma medications was 2.2 ± 0.56. Follow-up averaged (±SD) 32.6 ± 8.1 months (range, 30 to 45 months). Overall success, defined as postoperative intraocular pressure of 19 mm Hg or less with one pressure-reducing agent, was attained in 15 eyes (60%), with five eyes (20%) being controlled without medication. Considering all successfully treated patients, the mean intraocular pressure was 17.7 ± 3.1 mm Hg (range, 10 to 19 mm Hg) at the final visit. Mean intraocular pressure reduction was 17.1 ± 7.1 mm Hg in these eyes, representing a net decrease from baseline of 49%. Number of antiglaucoma medications dropped to 0.63 ± 0.29. Complications included localized Descemet membrane detachment in five eyes (20%) and moderate anterior chamber bleeding in four eyes (16%). CONCLUSIONS: This new surgical technique can effectively control intraocular pressure for long periods of time in patients with open-angle glaucoma and a history of failed filtering procedures. Goniocurettage may be a suitable alternative to surgical treatment of glaucoma patients with excessive conjunctival scarification.