Goniotomy Ab interno “a glaucoma filtering surgery” using the fugo plasma blade

PurposeTo correlate outflow function and outflow tract vessel diameter changes induced by nitric oxide (NO).MethodsIn a porcine anterior segment perfusion model, the effects of a nitric oxide donor (100 μM DETA-NO) on outflow facility were compared with controls (n = 8 per group) with trabecular meshwork (TM) and after circumferential ab interno trabeculectomy (AIT). Outflow structures were assessed with spectral-domain optical coherence tomography (SD-OCT) before and after NO, or an NO synthase inhibitor (100 μM L-NAME) and the vasoconstrictor, endothelin-1 (100 pg/mL ET-1). Scans were processed with a custom macroscript and aligned for automated reslicing and quantification of cross-sectional outflow tract areas (CSA).ResultsThe facility increased after DETA-NO (Δ of 0.189 ± 0.081 μL/min·mm Hg, P = 0.034) and AIT (Δ of 0.251 ± 0.094 μL/min·mm Hg, P = 0.009), respectively. Even after AIT, DETA-NO increased the facility by 61.5% (Δ of 0.190 ± 0.074 μL/min·mm Hg, P = 0.023) and CSA by 13.9% (P < 0.001). L-NAME + ET-1 decreased CSA by −8.6% (P < 0.001). NO increased the diameter of focal constrictions 5.0 ± 3.8-fold.ConclusionsNO can dilate vessels of the distal outflow tract and increase outflow facility in a TM-independent fashion. There are short, focally constricting vessel sections that display large diameter changes and may have a substantial impact on outflow.

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confidence: 99%

Structure–Function Changes of the Porcine Distal Outflow Tract in Response to Nitric Oxide

Waxman

Wang

Dang

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…The instrument functions as a sharp and precise cutting tool allowing the surgeon to construct a round capsulotomy without tearing and stretching the capsule 78. It has also been used for transciliary filtration,9 construction of corneal incisions10 and enlargement of anterior phimotic capsulorhexis 11. In our study, we used the plasma knife to cut the vascularized posterior capsule and the retrolental stump in eyes with anterior PHPV, and none of the eyes had a hemorrhage during the intraoperative and postoperative periods.…”

Section: Discussionmentioning

confidence: 96%

“…The Fugo plasma blade (MediSurg Research and Management Corp., Norristown, PA, USA) has recently been approved for performing capsulotomies, iridotomies and transciliary filtration 67891011. The Fugo Blade tip comes in different lengths and can be bent as required.…”

Section: Introductionmentioning

confidence: 99%

Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous

Sinha

Bali

Kumar

et al. 2013

Middle East Afr J Ophthalmol

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Purpose:To report the feasibility and outcome of lens aspiration, and Fugo blade-assisted capsulotomy and anterior vitrectomy in eyes with anterior persistent hyperplastic primary vitreous (PHPV).Materials and Methods:In this case series, 10 eyes of 10 patients with anterior PHPV underwent lens aspiration. The vascularized posterior capsule was cut with a Fugo blade (plasma knife) and removed with a vitrector. A foldable posterior chamber intraocular lens (IOL) was implanted in eight eyes and the outcomes were evaluated.Results:The mean age of patients was 16.8 ± 6.37 months (range: 5 to 28 months). The surgery was completed successfully in all eyes. There were no cases of intraocular hemorrhage intraoperatively. Foldable acrylic IOL was implanted in the bag in 3 eyes and in the sulcus in 5 eyes. Two eyes were microphthalmic and did no undergo IOL implantation (aphakic). None of the eyes had a significant reaction or elevated intraocular pressure postoperatively. The follow-up ranged from 4 to 21 months. All the pseudophakic eyes achieved a best corrected visual acuity of ≥20/200 with 50% (4/8) of these eyes with ≥20/60 vision.Conclusion:Lens aspiration followed by posterior capsulotomy with Fugo blade-assisted plasma ablation is a feasible technique for performing successful lens surgery in cases with florid anterior PHPV.

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“…15 CC diameter changes from IOP variations 16 and with the cardiac pulse wave 17 do not explain the remaining distal outflow resistance, nor do valves at the orifices of collector channels 18 as their removal by deep sclerotomy fails to reduce IOP further. 19,20 In this study, we hypothesized that NO, an established hypotensive agent, can increase the facility in a TM-independent manner by dilating outflow tract vessels. We investigated its effect with and without circumferential AIT, developed an automated, quantitative, and live analysis of the cross-sectional area (CSA) of intrascleral outflow vessels, and searched for evidence of focal dilation and constriction that may show a reactive outflow regulatory mechanism.…”

Section: Introductionmentioning

confidence: 99%

Structure-Function Changes of the Distal Outflow Tract in Response to Nitric Oxide

Waxman¹,

Wang²,

Dang³

et al. 2018

Preprint

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Purpose: To correlate outflow function and outflow tract vessel diameter changes induced by nitric oxide (NO).Methods: In a porcine anterior segment perfusion model, the effects of a nitric oxide donor (100 µM DETA-NO) on outflow facility were compared to controls (n=8 per group) with trabecular meshwork (TM) and after circumferential ab interno trabeculectomy (AIT). Outflow structures were assessed with spectral domain optical coherence tomography (SD-OCT) before and after NO, or an NO synthase inhibitor (100 µM L-NAME) and the vasoconstrictor, endothelin-1 (100 pg/mL ET-1). Scans were processed with a custom macro script and aligned for automated reslicing and quantification of cross-sectional outflow tract areas (CSA). Results:The facility increased after DETA-NO (0.189±0.081 μL/min·mmHg, p=0.034) and AIT (0.251±0.094 μL/min·mmHg, p=0.009), respectively. Even after AIT, DETA-NO increased the facility by 61.5% (0.190±0.074 μL/min·mmHg, p=0.023) and CSA by 13.9% (p<0.001). L-NAME + ET-1 decreased CSA by -8.6% (p<0.001). NO increased the diameter of focal constrictions 5.0±3.8 fold.Conclusions: NO can dilate vessels of the distal outflow tract and increase outflow facility in a TMindependent fashion. There are short, focally constricting vessel sections that display large diameter changes and may have a substantial impact on outflow.

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Goniotomy Ab interno “a glaucoma filtering surgery” using the fugo plasma blade

Abstract: Sixteen eyes with absolute glaucoma were treated and followed up for a minimum of six months. Goniotomy ab interno using the Fugo Blade was found to be a safe alternative to conventional trabeculectomy, which safely and effectively reduced intraocular pressure in more than 80% of cases.

Cited by 13 publications

References 1 publication

Structure–Function Changes of the Porcine Distal Outflow Tract in Response to Nitric Oxide

Structure–Function Changes of the Porcine Distal Outflow Tract in Response to Nitric Oxide

Results of cataract surgery and plasma ablation posterior capsulotomy in anterior persistent hyperplastic primary vitreous

Structure-Function Changes of the Distal Outflow Tract in Response to Nitric Oxide

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