Needle guided ab interno technique for tube insertion through the ciliary sulcus in uncontrolled glaucoma.

PURPOSE: To describe a modified ab interno technique for the tube implantation from a glaucoma draining device into the ciliary sulcus. MATERIALS AND METHODS: The modified ab interno technique was performed on four eyes of four patients. RESULTS: After the plate was fixed, a 21G needle is inserted through a paracentesis 180° away from the tube position into the anterior chamber and advanced to the posterior chamber through the sclera; finally, the needle exits the eye, then the tube is inserted into the lumen of the needle. The tube is then inserted simultaneously as the 21G needle is pulled out so the tube is placed on the ciliary sulcus. CONCLUSIONS: We report a simple and novel technique for the tube implantation from a glaucoma draining device into the ciliary sulcus, in which the tube is guided with a 21G needle from an accessory paracentesis in order to achieve a posterior placement of the tube.

Outcomes of Combined Prolene Gonioscopy Assisted Transluminal Trabeculotomy with Phacoemulsification in Open-Angle Glaucoma.

PURPOSE: To describe the clinical outcomes of combined prolene gonioscopy assisted transluminal trabeculotomy (GATT) with phacoemulsification in patients with open-angle glaucoma. METHODS: Retrospective study of patients with cataract and open-angle glaucoma treated with GATT and phacoemulsification with intraocular lens (IOL) implantation. Patients with neovascular glaucoma, corneal decompensation, unstable IOL, and with bleeding disorders were excluded. The cumulative probability of failure was the primary outcome. Secondary outcomes were the complete success rate, the mean change on intraocular pressure (IOP), best-corrected visual acuity (BCVA) and number of glaucoma medications at the last follow-up. The frequency of complications was also recorded. RESULTS: Thirty two eyes (25 patients) were included. Nineteen (59.3%) were females, with a mean age of 73.4±12.4 (23-87 years) and a mean baseline BCVA of 1.1±0.75 (0.3-3) LogMAR units. The cumulative probability of failure was 3.2% at 1 month and 6.3% at 6 and 12 months. Sixty-eight and 65.5% of eyes achieved complete success at 3 and 6 months, respectively. The reduction of IOP and number of glaucoma medications at 6 months were statistically significant (p<0.0001 and p=0.0002, respectively). There was a statistically significant improvement of BCVA (from 1.1±0.7 to 0.4±0.7) at 6 months (p<0.0001). IOP spikes (18.7%) and transient hyphema (9.3%) were the most common complications. CONCLUSION: Combined GATT with cataract surgery reduced the IOP and was associated with low failure rates and few ocular complications. This procedure offers the advantage to avoid the need for a bleb, scleral, or conjunctival incision, allowing the possibility for future glaucoma procedures.