An Alternate Technique for Goniotomy: Description of Procedure and Preliminary Results

Abstract

Purpose: Multiple glaucoma treatment modalities seek to lower IOP by bypassing or removing a portion of the juxtacanalicular trabecular meshwork. These procedures often require expensive implants or specialized surgical instruments. The authors developed a technique for ab interno goniectomy utilizing a standard disposable 25-gauge hypodermic needle. The surgical procedure—termed bent ab interno needle goniectomy (BANG)—and preliminary results are presented here.
 Methods: A retrospective chart review was performed for all patients who underwent goniotomy using a modified hypodermic needle by one of the three authors between July 2017 and June 2018. The mean and standard deviation pre- and postoperative IOP and the number of glaucoma medications were calculated. The student paired t-test was used to compare pre- and postoperative data. A P-value of <0.05 was considered statistically significant.
 Results: At postoperative month six, the mean IOP was 13.3 ± 2.5 mmHg (P = 3.6 × 10−7) on 0.5 ± 0.8 topical glaucoma medications (P = 0.01). A ≥20% reduction in IOP was achieved in 73% of patients. Seventy-three percent of patients required ≥1 fewer medication, while 73% of patients required no medications for IOP control. Forty-one percent of those treated achieved IOP ≤12 mmHg.
 Conclusion: The BANG procedure is a low-cost MIGS technique available to surgeons around the world with preliminary outcomes similar to more expensive alternatives.

Prediction of MIGS outcomes on second eyes using first eyes’ response

“…A Swan-Jacob gonioprism was placed on the cornea, and the patient’s head was tilted to visualize the nasal angle. MIGS procedures, including Hydrus microstent implantation, [11] canaloplasty using the OMNI Surgical System, [12] bent ab-interno needle goniotomy, [13] Kahook Dual Blade goniotomy, [14] and iStent inject implantation, [15] were performed according to their instructions for use or previously described methods. If a patient received a combined canaloplasty using OMNI Surgical System with Hydrus Microstent, a 180-degree ab-interno canaloplasty was performed first.…”

Minimally Invasive Glaucoma Surgery

“…Another alternative is the bent ab interno needle goniotomy technique 68 . This procedure, introduced by Shute et al in 2022, involves creating a specialized goniotome by bending the distal 1 mm of a sterile 25-gauge 5/8 inch hypodermic needle toward the bevel using a needle driver 68 . This needle is then used to excise the TM 68 .…”

“…This procedure, introduced by Shute et al in 2022, involves creating a specialized goniotome by bending the distal 1 mm of a sterile 25-gauge 5/8 inch hypodermic needle toward the bevel using a needle driver 68 . This needle is then used to excise the TM 68 . According to the authors, the bent ab interno needle goniotomy procedure is a cost-effective MIGS option that demonstrates initial outcomes comparable with more expensive alternatives 68 .…”

“…This needle is then used to excise the TM 68 . According to the authors, the bent ab interno needle goniotomy procedure is a cost-effective MIGS option that demonstrates initial outcomes comparable with more expensive alternatives 68 . A prospective study to analyze the safety and efficacy of the procedure is ongoing 68 …”

Editorial – An Alternate Technique for Goniotomy

“…Shute and colleagues report in this issue of the Journal of Ophthalmic and Vision Research the results of a novel low-cost approach for performing trabeculotomy and removal of trabecular meshwork with a 25G hypodermic needle, which they call BANG (bent ab interno needle goniectomy). [ 1 ] The premise is that this simple and low-tech approach can remove the trabecular meshwork and reduce the IOP as well as existing techniques such as goniotomy with Kahook Dual Blade (KDB) or trabeculotomy with Trabectome, which are costly due to the need for special instrumentation.…”