Effect of Combined Ab Interno 360 Degree Viscodilation and Goniotomy on Intraocular Pressure and Med

Effect of Combined Ab Interno 360 Degree Viscodilation and Goniotomy on Intraocular Pressure and Medication Use in Patients with Moderate-to- Severe Refractory Open Angle Glaucoma with and without Cataract Surgery

2019

Author: Abayomi Fabunmi, MD

Contributors: Steven Sarkisian, MD

Purpose:

To evaluate the effect of combined 360-degree ab-interno Schlemm’s canal viscodilation and goniotomy on intraocular pressure (IOP) and use of hypotensive medications in patients with moderate to severe, refractory open-angle glaucoma (OAG) using OMNI® Surgical System (OMNI procedure) with or without cataract extraction (CE).

Methods:

A retrospective case series of patients with moderate to severe OAG who received surgery with the OMNI procedure. All cases were performed at a single center (McGee Eye Institute, Oklahoma City) between February and July 2018. Patients were evaluated for changes in intraocular pressure (IOP), use of hypotensive medications and adverse events (AE). Outcome measures were collected pre-operatively and at post op day 1, 7, 30, 90, and 180 as available.

Results:

34 patients, age 71.8±8.4 years (59% female) were included after at least one month of follow up. Five eyes had previous intraocular glaucoma surgery. Mean IOP was 20.2±6.1, and drop use was 2.1±1.1. At post op month one, 21 (62%) patients had an IOP =/< their="" pre-op="" iop="" with="" fewer="" drops.="" this="" group="" had="" no="" post="" op="" iops="" less="" than="" 5="" or="" greater="" than="" 21mmhg.="" iop="" decreased="" by="" 30%="" (5.2mmhg)="" from="" 21.8±5.2="" to="" 15.3±3.9;="" /><0.0001. hypotensive="" drops="" use="" decreased="" by="" 69%="" (1.3drops)="" from="" 1.9±1.1="" to="" 0.6±0.9;=""><0.0001. drug-independence="" (0="" meds)="" was="" achieved="" in="" 18/34="" eyes="" (53%).="" three="" eyes="" required="" additional="" surgery="" for="" iop="" control.="" transient="" hyphema="" occurred="" in="" 6="" cases="" (17.6%).="" drug-independence="" (0="" meds)="" was="" achieved="" in="" 18/34="" eyes="" (53%).="" three="" eyes="" required="" additional="" surgery="" for="" iop="" control.="" transient="" hyphema="" occurred="" in="" 6="" cases="">

Conclusions:

Short-term outcomes indicate that the OMNI procedure can reduce hypotensive drop dependence and lower intraocular pressure while maintaining a favorable safety profile in moderate and advanced stages of glaucoma.