Citation Information :
Tamçelik N, Capar O, Atalay E. Modified Viscotrabeculotomy with Microcatheter: Our Technique and Experience in the Surgical management of Glaucoma. J Curr Glaucoma Pract 2019; 13 (3):88-93.
Aims: To present the results of our case series with a technique we defined as “modified viscotrabeculotomy” which incorporates the benefits of 360° of trabeculotomy and viscodilation and viscodissection of canal of Schlemm using a microcatheter.
Materials and methods: This study was designed as a prospective interventional case series and was conducted in Cerrahpasa Medical School Ophthalmology Clinic. Forty-one eyes of 30 patients diagnosed with congenital glaucoma (CG) underwent modified viscotrabeculotomy surgery following initial preoperative examination. The main outcome measure was the surgical success of the procedure, which is determined by an intraocular pressure (IOP) of <18 mm Hg without medication or resurgery; qualified success is defined as an IOP of <18 mm Hg under general anesthesia with an additional need for medications. The differences in IOP measurements were analyzed using paired analysis of variance (ANOVA) with repeated measures.
Results: The mean preoperative IOP of the patients was 32.27 ± 4.89 mm Hg. The IOP values at the 1st, 3rd, 6th postoperative months, and at the last visit were 13.41 ± 2.25 mm Hg, 13.70 ± 1.78 mm Hg, 12.47 ± 1.57 mm Hg, and 12.26 ± 1.81 mm Hg, respectively. The difference between the preoperative IOP values and postoperative IOP values was statistically significant (p < 0.001). The qualified surgical success rate was 94.4% after a mean follow-up of 27.95 ± 8.25 months (range 15–45 months).
Conclusion: Modified viscotrabeculotomy is a safe and effective treatment in the management of CG.
Ou Y, Caprioli J. Surgical management of pediatric glaucoma. Dev Ophthalmol 2012;50:157–172. DOI: 10.1159/000334798.
Ikeda H, Ishigooka H, Muto T, et al. Long-term outcome of trabeculotomy for the treatment of developmental glaucoma. Arch Ophthalmol 2004;122(8):1122–1128. DOI: 10.1001/archopht.122.8.1122.
Tamçelik N, Ozkiriş A. A comparison of viscogoniotomy with classical goniotomy in Turkish patients. Jpn J Ophthalmol 2004;48(4):404–407. DOI: 10.1007/s10384-004-0088-5.
Yu Y, Liu ZL, Cao L, et al. Clinical effect of improved viscocanalostomy for the treatment of primary congenital glaucoma. Int J Ophthalmol 2012;5(4):466–468. DOI: 10.3980/j.issn.2222-3959.2012.04.11.
Tamcelik N, Ozkiris A. Long-term results of viscotrabeculotomy in congenital glaucoma: comparison to classical trabeculotomy. Br J Ophthalmol 2008;92(1):36–39. DOI: 10.1136/bjo.2007.114389.
Tamcelik N, Ozkiris A, Sarici AM. Long-term results of combined viscotrabeculotomy-trabeculectomy in refractory developmental glaucoma. Eye (Lond) 2010;24(4):613–618. DOI: 10.1038/eye.2009.185.
Francis BA, Singh K, Lin SC, et al. Novel glaucoma procedures: a report by the American Academy of Ophthalmology. Ophthalmology 2011;118(7):1466–1480. DOI: 10.1016/j.ophtha.2011.03.028.
Grehn F. Congenital glaucoma surgery: a neglected field in ophthalmology? Br J Ophthalmol 2008;92(1):1–2. DOI: 10.1136/bjo.2007.126458.
Meyer G, Schwenn O, Pfeiffer N, et al. Trabeculotomy in congenital glaucoma. Graefes Arch Clin Exp Ophthalmol 2000;238(3):207–213. DOI: 10.1007/s004170050345.
Razeghinejad MR, Fudemberg SJ, Spaeth GL. The changing conceptual basis of trabeculectomy: a review of past and current surgical techniques. Surv Ophthalmol 2012;57(1):1–25. DOI: 10.1016/j.survophthal.2011.07.005.
Tamm ER, Carassa RG, Albert DM, et al. Viscocanalostomy in rhesus monkeys. Arch Ophthalmol 2004;122(12):1826–1838. DOI: 10.1001/archopht.122.12.1826.
Smit BA, Johnstone MA. Effects of viscoelastic injection into Schlemm's canal in primate and human eyes: potential relevance to viscocanalostomy. Ophthalmology 2002;109(4):786–792. DOI: 10.1016/S0161-6420(01)01006-5.
Higashide T, Sugiyama K. Use of viscoelastic substance in ophthalmic surgery-focus on sodium hyaluronate. Clin Ophthalmol 2008;2(1):21–30. DOI: 10.2147/OPTH.S1439.
Mandal AK, Chakrabarti D. Update on congenital glaucoma. Indian J Ophthalmol 2011;59(Suppl):S148–S157. DOI: 10.4103/0301-4738.73683.
Mendicino ME, Lynch MG, Drack A, et al. Long-term surgical and visual outcomes in primary congenital glaucoma: 360 degrees trabeculotomy versus goniotomy. J AAPOS 2000;4(4):205–210. DOI: 10.1067/mpa.2000.106201.
Sarkisian SR. An illuminated microcatheter for 360-degree trabeculotomy [corrected] in congenital glaucoma: a retrospective case series. J AAPOS 2010;14(5):412–416. DOI: 10.1016/j.jaapos.2010.07.010.
Girkin CA, Marchase N, Cogen MS. Circumferential trabeculotomy with an illuminated microcatheter in congenital glaucomas. J Glaucoma 2012;21(3):160–163. DOI: 10.1097/IJG.0b013e31822af350.