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Other Procedures for Pediatric Glaucoma Surgery: New Devices and Techniques

  • Elena Bitrian
  • Alana L. Grajewski
Chapter

Abstract

In recent years, multiple new devices have been developed in glaucoma surgery that target the angle and can be grouped in the category of minimally invasive glaucoma surgeries (MIGS). These procedures were developed mainly for adult glaucoma surgery, but many have potential application in pediatric glaucoma patients, although there is limited experience in children for most of the MIGS.

When considering new and novel techniques, it is always best to look back at the principal foundations leading to these innovations. The origin of pediatric glaucoma surgery dates back to 1938 with Barkan describing his goniotomy technique. While classical angle surgery still continues to be a first-line treatment in primary congenital glaucoma (PCG), in recent years modifications in this technique and new devices have been developed. If the first angle surgery is not successful and the angle has not been treated 360°, many surgeons will further treat the angle before performing a filtering procedure (trabeculectomy) or glaucoma drainage device. Several instruments and techniques have been developed to extend the area of angle first treated and/or to remove the trabecular meshwork (TM) from the eye or dilate Schlemm’s canal.

This chapter presents new surgical techniques and devices that target the angle via an ab interno approach and are classified as MIGS: trabeculotomy with TRAB™360, viscodilation with VISCO™360, combined trabeculotomy and viscodilation with the OMNI™, gonioscopic-assisted transluminal trabeculotomy with fiber optic or suture, and TM destruction and removal with Trabectome®/Goniotome and Kahook dual blade®. These devices share indications, complications, advantages, and limitations.

Keywords

TRAB™360 VISCO™360 OMNI™ Kahook dual blade (KDB) Trabectome/Goniotome Gonioscopic-assisted transluminal trabeculotomy (GATT) 

Supplementary material

Video 9.1

Bioniko eye model for simulation of angle surgery. The TRAB™360 surgical technique and GATT are performed in this model (MP4 189899 kb)

Video 9.2

TRAB™360 surgical technique . The instrument is used to pierce the trabecular meshwork; the inner filament is threaded 180° in Schlemm’s canal and then unroofed. The same procedure is performed for the remaining 180°. (Video courtesy of James D. Brandt, MD) (MP4 356411 kb)

Video 9.3

Gonioscopic-assisted transluminal trabeculotomy (GATT) with the iTrack™ catheter . The catheter is grasped and directed to the opening in Schlemm’s canal. The catheter is then fed into the canal and then Schlemm’s canal is unroofed. (Courtesy of Alana L. Grajewski, MD) (MP4 97716 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of OphthalmologyMayo ClinicRochesterUSA
  2. 2.Samuel & Ethel Balkan International Pediatric Glaucoma Center, Bascom Palmer Eye Institute, University of Miami Miller School of MedicineMiamiUSA

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