Microendoscopic trabecular surgery in glaucoma management

OBJECTIVE: To evaluate the safety and efficacy of trabecular surgery under microendoscopic control in the management of advanced chronic open-angle glaucoma when the presence of corneal opacification obscures adequate visualization of the anterior segment. STUDY DESIGN: Comparative interventional case series. PARTICIPANTS AND INTERVENTION: Fifteen eyes of 15 patients with medically uncontrolled open-angle glaucoma and moderate-to-severe corneal opacification underwent trabecular surgery under microendoscopic control. Seven eyes were treated by photoablative laser goniopuncture and eight eyes by goniocurettage. MAIN OUTCOME MEASURES: The intraocular pressure (IOP) and number of medications before and after surgery were measured. Intraoperative and postoperative complications were analyzed. RESULTS: The ophthalmic microendoscope was successfully used in visualizing and identifying the anterior chamber angle structures and in controlling the trabecular surgical procedures in all eyes. The IOP dropped from 34.5 +/- 6.9 millimeters of mercury (mmHg) (range, 27-46 mmHg) under maximal-tolerated medical therapy before surgery to 18.5 +/- 3.0 mmHg (range, 15-23 mmHg) at 21 months after surgery. Medication averaged 2.3 +/- 0.6 before surgery and dropped to 1.0 +/- 0.7 at last follow-up. No difference was observed in the surgical outcome between the laser-treated eyes and those receiving goniocurettage. No severe intraoperative or postoperative complications relating to either the trabecular surgery or to the use of the microendoscope were observed. CONCLUSION: The ophthalmic microendoscope appears to be safe and effective in simultaneously providing illumination, video recording, and clear endoscopic view of the fine details of the anterior chamber angle structures. Microendoscopy enables various trabecular surgical procedures, such as goniocurettage or photoablative laser goniopuncture, which can be performed in the presence of corneal opacification that might otherwise preclude adequate visualization and treatment. It thus appears that microendoscopic trabecular surgery may in the future be considered as an alternative choice of surgical treatment in some cases of open-angle glaucoma.