Ab Interno Goniotomy/Goniectomy Techniques

Minimally invasive glaucoma surgeries (MIGS), such as Kahook Dual Blade (KDB), bent ab interno needle goniectomy (BANG), gonioscopy-assisted transluminal trabeculotomy (GATT), OMNI, Trabectome, Streamline, and TrabEx+, have significantly advanced the treatment of glaucoma by improving aqueous humor outflow and reducing intraocular pressure (IOP). These innovative procedures target the trabecular meshwork (TM) and Schlemm’s canal, offering effective alternatives to more invasive filtration surgeries. By enhancing the natural drainage pathways, MIGS can achieve notable reductions in IOP and minimize the need for long-term glaucoma medications. Each device has a distinct mechanism of action. The KDB excises a strip of TM, while BANG uses a bent hypodermic needle for controlled goniectomy. GATT performs a 360-degree trabeculotomy using a microcatheter or Prolene (polypropylene) suture to open Schlemm’s canal. OMNI combines canaloplasty and trabeculotomy in a single procedure. The Trabectome ablates TM tissue with electrical energy, whereas Streamline performs viscodilation to expand outflow channels. TrabEx+ facilitates goniectomy with integrated irrigation and aspiration. Clinical studies have shown these MIGS techniques to be both safe and effective, with fewer complications compared to traditional surgeries like trabeculectomy or tube shunt implantation. MIGS procedures are particularly appealing due to their reduced recovery time and lower risk profile. However, further research is essential to establish their long-term efficacy and durability. Continued advancements and comprehensive long-term studies will ensure that MIGS provide sustainable and reliable benefits for glaucoma patients, optimizing treatment strategies in clinical practice.