On April 10, 2023, Professor Wang Ningli, a prestigious glaucoma expert in China and Honorary Director of Department of Ophthalmology in the First Affiliated Hospital (FAH) of Xi 'an Jiaotong University (XJTU), led the glaucoma team including Chief Physician Kang Qianyan, Deputy Chief Physician Cui Lijun and Attending Physician Gao Shan, to successfully perform minimally invasive glaucoma surgery for three patients with intimate cooperation from Department of Anesthesiology and Perioperative Medicine, including two cases of minimally invasive trabeculotome tunneling trabeculoplasty surgery (3T), the first case in northwest China. The successful implementation of 3T surgery signifies that Department of Ophthalmology of the hospital has mastered the techniques of minimally invasive glaucoma surgery!
A 44-year-old male patient, surnamed Wang, was diagnosed with open-angle glaucoma in bilateral eyes three years ago. He underwent traditional glaucoma filtering surgery for right eye in a local hospital and achieved poor efficacy. To further treat the left eye, he was transferred to the FAH for 3T surgery, and intraocular pressure of the left eye was effectively decreased to 6mmHg at postoperative 1 d.
A week ago, a 71-year-old elderly patient, surnamed Lei, was admitted to Department of Ophthalmology of the hospital due to swelling pain in his right eye and decreased visual acuity for 1 week. He was diagnosed with open-angle glaucoma. After preoperative consultation by Professor Wang Ningli, the patient successfully underwent 3T surgery, and intraocular pressure was 8mmHg at postoperative 1 d, which protected the residual visual acuity and visual field to the largest extent.
On the same day, gonioscopy-assisted transluminal trabeculotomy (GATT) was also performed for a 3-year-old patient. He suffered from red nevus on the left face since birth. Two months ago, intraocular pressure of the left eye was high up to 39-45mmHg. The diagnosis of Sturge-Weber syndrome was confirmed. The glaucoma team of the hospital successfully performed surgery, and postoperative intraocular pressure was declined to 17mmHg.
Diagram of mechanism of intraocular pressure reduction in 3T surgery
During 3T surgery, a microincision is created at the trabecular meshwork, surgical suture was introduced into Schlemm’s canal by a microcatheter and viscoelastic agent was injected via the microcatheter, which can simultaneously resolve the issues of Schlemm's canal collapse, protrusions of the trabecular meshwork into Schlemm's canal (hernias) and collector channel occlusion,etc. The tension suture kept in Schlemm's canal can continuously pull Schlemm's canal and prevent the collapse of Schlemm's canal, thereby delivering the drainage of aqueous humor and lowering intraocular pressure. 3T surgery can avoid the use of scleral flap with external large incision. Under gonioscope-assisted intraoperative procedures, iTrack or Usight microcatheter system can be utilized to restorenormal anatomical structure of anterior chamber angle, which possesses multiple advantages of safety, high intraocular pressure-lowering effect and rapid postoperative recovery. 3T surgery represents the cutting-edge minimally invasive surgery for glaucoma worldwide.
