Observation of Schlemm’s canal and transluminal trabeculotomy using an ophthalmic endoscope: a case report

Abstract

Background Gonioscopy-assisted transluminal trabeculectomy is a novel and useful technique for ab interno trabeculotomy. However, gonioscopy-assisted transluminal trabeculectomy is difficult to perform in patients with corneal opacity or in patients with sequelae of cerebral infarction and cervical osteoarthritis with severe limitation of spinal mobility. This is because observing Schlemm’s canal during surgery using gonioscopy is difficult. In this report, we introduce a new and beneficial surgical technique of transluminal trabeculotomy for these patients, using an ophthalmic endoscope for cases in which normal gonioscopy-assisted transluminal trabeculectomy is difficult. Case presentation Our patient was a 65-year-old Japanese man with cervical osteoarthritis with severe limitation of spinal mobility who showed primary open-angle glaucoma of the right eye. He had limited conversion of his head during surgery because of complications. Therefore, we performed transluminal trabeculotomy using an ophthalmic endoscope. Finally, ab interno trabeculotomy of 200 degrees was achieved by this method, and an average reduction in ocular pressure of 60% from baseline was achieved after surgery, with no major complications. Conclusions This surgical technique may be useful as an alternative method for normal gonioscopy-assisted transluminal trabeculectomy in difficult cases. Electronic supplementary material The online version of this article (10.1186/s13256-019-2186-5) contains supplementary material, which is available to authorized users.

Case Report: Gonio-endoscopy: a novel approach to minimally invasive glaucoma surgery in a glaucomatous eye

“…Afterward, in 2001, Joos reported a coaxial endoscopic goniotomy with a thin blood lancet wrapped tightly around a 20-gauge ocular endoscope ( 4 ). Recently, Nakao reported a surgical technique of transluminal trabeculotomy using a 23-gauge ocular endoscope for patients with limited conversion of his head ( 5 ). Previous ocular endoscopes have a straight probe.…”

“…Therefore, it is difficult to perform in cases with corneal opacity or limitation of neck movement. An ocular endoscope facilitates the performance of gonio-surgery without the usual surgical techniques for MIGS, as mentioned ( 3 – 5 ).…”

Ab-interno trabeculotomy procedures: A review

“…However, this can be surpassed by using an ophthalmic endoscopic technique. 59 Furthermore, it has been recommended to reconsider GATT performance in patients who cannot tolerate head elevation during the first 2 weeks of surgery until the resolution of the possible postoperative hyphema. 16 …”