An Alternate Technique for Goniotomy: Description of Procedure and Preliminary Results

Purpose: multiple glaucoma treatment modalities seek to lower iop by bypassing or removing a portion of the juxtacanalicular trabecular meshwork. these procedures often require expensive implants or specialized surgical instruments. the authors developed a technique for ab interno goniectomy utilizing a standard disposable 25-gauge hypodermic needle. the surgical procedure—termed bent ab interno needle goniectomy (bang)—and preliminary results are presented here. methods: a retrospective chart review was performed for all patients who underwent goniotomy using a modified hypodermic needle by one of the three authors between july 2017 and june 2018. the mean and standard deviation pre- and postoperative iop and the number of glaucoma medications were calculated. the student paired t-test was used to compare pre- and postoperative data. a p-value of <0.05 was considered statistically significant. results: at postoperative month six, the mean iop was 13.3 ± 2.5 mmhg (p = 3.6 × 10−7) on 0.5 ± 0.8 topical glaucoma medications (p = 0.01). a ≥20% reduction in iop was achieved in 73% of patients. seventy-three percent of patients required ≥1 fewer medication, while 73% of patients required no medications for iop control. forty-one percent of those treated achieved iop ≤12 mmhg. conclusion: the bang procedure is a low-cost migs technique available to surgeons around the world with preliminary outcomes similar to more expensive alternatives.