Irrigating bent ab-interno needle goniectomy (i-BANG) technique

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Treatment

Background:

• The bent ab-interno needle goniectomy (BANG) is a cost-effective modification for excisional goniectomy.
• Reflux bleeding and anterior chamber shallowing can impede angle visualization during BANG.
• Existing methods to manage hyphema may cause delays and rebleeding.

Purpose of the Study:

• To describe a novel modification for managing intraoperative angle bleeding and anterior chamber shallowing.
• To ensure a clear angle view during ab-interno goniectomy.
• To evaluate the technique in 27 eyes with open-angle and angle-closure glaucoma.

Main Methods:

• A 1 mm 24 G needle is bent at a right angle to create the i-BANG goniectome.
• The needle hub connects to an infusion system, maintaining 100 mmHg IOP with continuous fluid infusion.
• A 120° goniectomy is performed with continuous nasal fluid infusion to clear blood.

Main Results:

• The i-BANG technique achieved passive aspiration at minimal cost.
• Intraoperative hyphema and anterior chamber shallowing were effectively managed.
• No cases required procedure abandonment or resulted in incomplete treatment.
• Minimal blood layering occurred in 12 eyes, resolving completely within one week.

Conclusions:

• The i-BANG technique provides a cost-effective solution for managing intraoperative complications in goniectomy.
• Continuous fluid infusion during i-BANG ensures clear angle visualization and prevents delays.
• The i-BANG procedure is safe and effective for glaucoma patients, with excellent visual outcomes.