Episcleral Venography: Possible Marker for MIGS Surgery Success

Determining the success of minimally-invasive glaucoma surgery (MIGS) intraoperatively is a challenge. But Dr. Ronald Fellman and colleagues have come up with a simple way to gauge trabecular outflow patency using what they call episcleral venography. In this interview from AAO 2016, Dr. Fellman describes the technique in which a surge of balanced salt solution (BSS) is infused into the anterior chamber. As BSS exits the eye through collector channels, the surgeon can observe the episclera for a blanching of blood caused by a washout wave of BSS, thereby offering an immediate view of the success of the procedure. In a paper published in the December 2015 issue of Ophthalmology, Dr. Fellman found that the episcleral venogram correlated with improved surgical outcomes for Trabectome surgery, and patients with a diffuse wave had a lower IOP, required fewer glaucoma medications, and had a lower requirement for further glaucoma surgery.