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 gl aucoma when the presence of corneal opacification obscures adequate visuali zation of the anterior segment. Study Design: Comparative interventional case series. Participants and intervention: Fifteen eyes of 15 patients with medically u ncontrolled open-angle glaucoma and moderate-to-severe corneal opacificatio n underwent trabecular surgery under microendoscopic control. Seven eyes we re treated by photoablative laser goinopuncture and eight eyes by goniocure ttage. Main Outcome Measures: The intraocular pressure (IOP) and number of medicat ions before and after surgery were measured. Intraoperative and postoperati ve complications were analyzed. Results: The ophthalmic microendoscope was successfully used in visualizing and identifying the anterior chamber angle structures and in controlling t he trabecular surgical procedures in all eyes. The IOP dropped from 34.5 +/ - 6.9 millimeters of mercury (mmHg) (range, 27-46 mmHg) under maximal-toler ated 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 surger y 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 rel ating 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 endosc opic view of the fine details of the anterior chamber angle structures, Mic roendoscopy enables various trabecular surgical procedures, such as goniocu rettage or photoablative laser goniopuncture, which can be performed in the presence of corneal opacification that might otherwise preclude adequate v isualization and treatment. It thus appears that microendoscopic trabecular surgery may in the future be considered as an alternative choice of surgic al treatment in some cases of open-angle glaucoma.