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Editors Selection IGR 8-1

Surgery: Ab interno glaucoma surgery

Comment by Roberto Carassa on:

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The paper by Pajic et al. (250) who report on a novel ab-interno glaucoma procedure is of great interest for the outstandingly high success rate reported with the use of a minimally invasive technique. The method recalls the ab-interno goniotomies or sclerostomies proposed in the mid 90's which were based on Erbium laser sources (Dietlein et al., 1997; Dietlein et al., 1998; Funk et al. 2000; Dietlein et al., 2001; Feltgen et al., 2003; Philippin et al., 2005). The advantage of all such techniques was to avoid conjunctival manipulation and to provide a bypass by which the aqueous could reach Schlemm's canal skipping the site of greater outflow resistance. The inconsistent results, the lower short-term success rate when compared to trabeculectomy and the overall cost of the laser procedures did not allow acceptance of such techniques in the clinical practice. Pajic's study was conducted using a

A novel ab interno procedure reports 77% of IOP's under 18 mmHg

simpler technology based on a custom-made high frequency bipolar probe which is likely to produce a relevant thermal damage in vivo, compared to the erbium laser device. The success of the procedure conducted on a sample of 53 eyes is indeed encouraging after a follow-up of two years: 45% of the cases had an IOP below 15 mmHg, 77% were below 18 mmHg and 91% were below 21 mmHg. Complications were minor, with 22.6% of the eyes displaying a transient IOP elevation and 11.4% a mild temporary hyphema. Interestingly, after a dishomogeneous early postoperatively reduction the IOP continued to decline and finally became stable after six months in a broad majority of the treated eyes. These oustanding results need to be confirmed and possibly compared to trabeculectomy.

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