Objective: To evaluate the safety and efficacy of trabecular surgery under
microendoscopic control in the management of advanced chronic open-angle glaucoma
when the presence of corneal opacification obscures adequate visualization of
the anterior segment.
Participants and Intervention: Fifteen eyes of 15 patients with medically
uncontrolled open-angle glaucoma and moderate to severe corneal opacification
underwent trabecular surgery under microendoscopic control. Nine eyes were
treated by photoablative laser goniopuncture and 12 eyes by goniocurettage.
Results: The ophthalmic microendoscope was successfully used in visualizing and
identifying the anterior chamber angle structures and in controlling the
trabecular surgical procedures in all eyes. IOP dropped from 31.5 ± 5.9 mmHg
(range, 25 - 41 mmHg) under maximal tolerated medical therapy before surgery to
19.1 ± 2.5 mmHg (range, 15 -23 mmHg) at 2.5 years after surgery. Medication
averaged 2.2 ± 0.5 before surgery and dropped to 1.0 ± 0.6 at last follow-up.
No difference was observed in the surgical outcome between the laser treated
eyes and those receiving goniocurettage. No severe intraoperative or postoperative
complications relating to either the trabecular surgery or to the use of the
microendoscope were observed.
Conclusion: The ophthalmic microendoscope appears to be safe
and effective in simultaneously providing illumination, video recording, and clear
endoscopic view of the fine details of the anterior chamber angle structures.
Microendoscopy enables various trabecular surgical procedures, such as
goniocurettage or photoablative laser goniopuncture, which can be performed in
the presence of corneal opacification that might otherwise preclude adequate
visualization and treatment. It thus appears, that microendoscopic trabecular
surgery may in future be considered as an alternative choice of surgical
treatment in some cases of open-angle glaucoma.