*3.2.2 Indications and contraindications*

The effectiveness of ELT is greater when performed in combination with cataract surgery [6]. Therefore, it is indicated alone or in combination with cataract surgery in most patients with OAG with hypotensive treatment and cataract in surgical stage to reduce IOP and medication [5].

It is not indicated in glaucomas with increased episcleral venous pressure or in those requiring very low target IOPs below episcleral venous pressure [5].

#### *3.2.3 Surgical technique*

The AC is filled with viscoelastic using the corneal incision made for cataract surgery and the probe is positioned in contact with the TM, which can be visualized by gonioscopy (**Figure 2(C)**) or by endoscopy, depending on the generation of the laser used [5]. Between 8 and 10 laser microperforations are made per 90° sector of the TM [5]. The parameters used by the laser are: 200 μm spot, 1.2 mJ pulse energy, 80 ns duration [5]. During the application of the laser, the whitening of the TM and the appearance of one or more bubbles are observed.

**29**

*3.3.4 Security*

*Cataract Surgery Combined with Trabecular MIGS (Minimally Invasive Glaucoma Surgery)*

(**Figure 2(C)**), sometimes associated with a slight reflux of blood that confirms the opening of the SC [5]. Finally, the probe is removed, the viscoelastic is washed,

This is a simple technique with a low incidence of complications. The main complications include hemorrhage in the immediate postoperative period and the fact that, due to the small size of the perforations, they are more easily obstructed

ELT can be performed on eyes that have previously undergone filtering surgery [5]. Its application in only 90° per session allows retreatment in the 3 remaining

It is a sectoral (90°) ab-interno MIGS technique in which the TM and the internal wall of the canal are bundled (similar to the procedure performed with the trabectome) with a device that is inserted into the TM and consists of a ramp in the distal end that, as we advance in the cut, raises the TM tissue and directs it towards 2 blades

Thanks to its approach, it can be easily combined with cataract surgery and the combination of both surgeries increases hypotensive efficacy [7, 8]. Therefore, it is indicated in different types of OAG (primary, secondary to pseudoexfoliation and pigment dispersion, corticosteroid and uveitic), with mild or moderate glaucoma damage in a stage prior to conventional surgery, combined with cataract surgery in patients with cataract in the surgical stage in whom a decrease in IOP and/or a

It should not be used in patients with advanced glaucoma or with a target IOP

The patient's head should be turned to the opposite side of the eye to be treated [5]. The corneal incision of cataract surgery is used to inject cohesive viscoelastic and introduce the kahook, which advances through the anterior chamber towards the nasal angle sector, which is visualized by gonioscopy [5]. The tip of the kahook is inserted through the TM into SC, and a cut is made along the TM in a clockwise direction, followed by another cut in an anti-clockwise direction, using the insertion site as a point of attachment reference (**Figure 2(B)**) [5]. The reflux of blood confirms the opening of the SC [5]. Finally, the device is removed, the viscoelastic is

The complication rate is low and comparable to that of Trabectome™, highlight-

washed, and the corneal incision is sealed by hydrating the stroma [5].

at the ends of the ramp that allow the cutting and extraction of this tissue [5].

and the corneal incision is sealed by hydrating the stroma [5].

than larger openings obtained with other procedures [5].

reduction in topical hypotensive medication is desired [5].

*DOI: http://dx.doi.org/10.5772/intechopen.95416*

sectors in future interventions [5].

*3.3.2 Indications and contraindications*

lower than episcleral venous pressure [5].

ing the bleeding in the anterior chamber [9].

*3.3.3 Surgical technique*

*3.2.4 Security*

**3.3 Kahook**

*3.3.1 Definition*

(**Figure 2(C)**), sometimes associated with a slight reflux of blood that confirms the opening of the SC [5]. Finally, the probe is removed, the viscoelastic is washed, and the corneal incision is sealed by hydrating the stroma [5].

### *3.2.4 Security*

*Current Cataract Surgical Techniques*

**28**

**3.2 ELT**

*second 180º.*

**Figure 2.**

*3.2.1 Definition*

ELT is an ab-interno MIGS technique in which microperforations or trabeculostomies are performed in the TM in order to facilitate the drainage of aqueous humor towards the SC using excimer laser impacts in a sectorial way (90°) of the TM [5]. Excimer laser photocoagulation allows the ablation of the juxtacanalicular wall of the TM and the internal wall of the Schlemm canal (avoiding injury to the external wall of the Schlemm canal containing fibroblasts, whose preservation is important for the drainage of the aqueous humor) with local and adjacent temperature control

*Surgical procedures. (A) Two iStent correctly implanted in the TM. (B) Kahook mades a cut along the TM in a clockwise direction, followed by another cut in an anti-clockwise direction. (C) During the application of the laser in ELT, the whitening of the TM and the appearance of one or more bubbles are observed. (D) OMNI introduces the blue microcatheter in the SC, first for 180º of the SC and then the process is repeated for the* 

The effectiveness of ELT is greater when performed in combination with cataract surgery [6]. Therefore, it is indicated alone or in combination with cataract surgery in most patients with OAG with hypotensive treatment and cataract in

those requiring very low target IOPs below episcleral venous pressure [5].

It is not indicated in glaucomas with increased episcleral venous pressure or in

The AC is filled with viscoelastic using the corneal incision made for cataract surgery and the probe is positioned in contact with the TM, which can be visualized by gonioscopy (**Figure 2(C)**) or by endoscopy, depending on the generation of the laser used [5]. Between 8 and 10 laser microperforations are made per 90° sector of the TM [5]. The parameters used by the laser are: 200 μm spot, 1.2 mJ pulse energy, 80 ns duration [5]. During the application of the laser, the whitening of the TM and the appearance of one or more bubbles are observed.

avoiding thermal damage to surrounding tissues [5].

surgical stage to reduce IOP and medication [5].

*3.2.2 Indications and contraindications*

*3.2.3 Surgical technique*

This is a simple technique with a low incidence of complications. The main complications include hemorrhage in the immediate postoperative period and the fact that, due to the small size of the perforations, they are more easily obstructed than larger openings obtained with other procedures [5].

ELT can be performed on eyes that have previously undergone filtering surgery [5]. Its application in only 90° per session allows retreatment in the 3 remaining

sectors in future interventions [5].
