Reticular patterned episcleral venous plexus and 360-degree episcleral venous fluid wave after hemi-gonioscopy assisted transluminal trabeculotomy

Julia Wiens,Matt Schlenker,Teong Lam Gooi,Danielle Wentzell,Malcolm Gooi,Patrick Gooi

doi:10.20517/2574-1225.2020.105

Julia Wiens, Matt Schlenker + Show 4 more

Open Access

https://doi.org/10.20517/2574-1225.2020.105

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Abstract

We describe a method for eliciting an episcleral venous fluid wave (EVFW) in eyes presenting with reticular patterned episcleral venous plexus, after a hemi-gonioscopy assisted transluminal trabeculotomy (hemi-GATT). To reduce the risk of post-operative hyphema and reduce intraoperative tissue manipulation, a hemi-GATT (targeting 180-degrees of Schlemm’s canal) was performed. Post-hemi-GATT, the ability to inject balanced salt solution and obtain an EVFW in both the treated (inferior) and untreated (superior) sectors of the eye supports the surgical success of the technique, and demonstrates an enhanced fluid outflow and subsequent vessel blanching. The pre-operative intraocular pressure of 20/21 mmHg in a single subject decreased to 18-, 12- and 15-mmHg after one day, one month and 3 months post-op, respectively, and the subject was rendered medication-free. This method of performing a hemi-GATT to effectively obtain an EVFW provides evidence for novel treatment algorithms in patients with a reticular episcleral venous plexus where identification of major outflow vessels is less apparent.

Highlights

Glaucoma stands as the leading cause of irreversible blindness worldwide and approximately 3% of the population between 40-80 years old have a primary open angle glaucoma[1]
An episcleral venous fluid wave (EVFW) is an intraoperative technique performed at the conclusion of a surgery wherein diffuse vessel blanching is achieved by injecting balanced salt solution (BSS) that flows into the conjunctival and episcleral venous systems, demonstrating possible patency of the conventional aqueous outflow system[3,6]
For an EVFW to be present, fluid must be able to travel from collector channel openings, through the deep and mid scleral plexuses to the episcleral plexus terminating in the conjunctival veins, thereby demonstrating an enhanced aqueous outflow[3]

Summary

Introduction

Glaucoma stands as the leading cause of irreversible blindness worldwide and approximately 3% of the population between 40-80 years old have a primary open angle glaucoma[1]. Growing evidence supports the correlation between the presence of an episcleral venous fluid wave (EVFW) and post-operative reductions in IOP as well as the need for fewer glaucoma medications and/or additional surgeries[3]. An EVFW is an intraoperative technique performed at the conclusion of a surgery wherein diffuse vessel blanching is achieved by injecting balanced salt solution (BSS) that flows into the conjunctival and episcleral venous systems, demonstrating possible patency of the conventional aqueous outflow system[3,6].

Results

Conclusion