ABiC has become my first-line treatment for such patients, however, primarily because it is effective and involves minimal recovery. Also, it does not preclude me from performing other surgeries in the future—if I have a patient in which response to ABiC treatment failed, I can always do filtering surgery later.
Since rejuvenating patients’ natural ocular outflow system in this manner, the need for further surgery has dramatically reduced. I was averaging close to eight filtering surgeries per week, but now I only need to perform about one filtering surgery per month because ABiC and other MIGS procedures have proven to be so effective.
The second subset of glaucoma patients in whom I tend to use ABiC first-line are those undergoing cataract surgery while controlled on medication. I use cataract surgery as an opportunity to eliminate the medication burden by also performing ABiC.
When we are heading to the operating room, I mention to patients that we will “flush out” their ocular drainage system and rejuvenate their natural filter, which will reduce their need for medication. Most patients are completely unfazed by this.
For patients who are not controlled on medication and need incisional surgery, I let them know I am going to try to utilize their natural drainage system, which will require only a short recovery period.
I also tell them that if the procedure does not work because their natural filter is severely damaged, I may need to perform another surgery to bypass their drainage system at some time in the future. Patients are quite open to this.
A key advantage of ABiC is that it can be used in all stages of glaucoma, although findings from my own case series study indicate that is most efficacious in mild-to-moderate disease. I recently undertook a 12-month study in 64 patients with mild-to-moderate glaucoma who underwent ABiC either alone or combined with cataract surgery. Overall, the mean IOP fell from 18.4 ± 6.2 mm Hg preoperatively to 14.1 ± 2.6 mm Hg (p< 0.037) at 12 months postoperatively—a reduction of 30.64%.
Medication burden was also reduced, from 2.45 ± 0.89 at baseline to 0.79 ± 0.90 at 12 months postoperatively (p< 0.0001)—a reduction of 67.75%.
A subset analysis showed the procedure was effective when performed alone and when combined with cataract surgery. With ABiC alone, there was a 26.34% reduction in IOP and 59.43% in medication at 12 months postoperatively. When combined with cataract surgery, IOP fell by 28.57% and medication use by 74.1%.