Novel, Low-Cost Glaucoma Procedure Shows Promise for Lowering Intraocular Pressure

Surgeon preparing patient for eye surgery
Surgeon preparing patient for eye surgery
The bent ab interno needle goniectomy procedure reduced intraocular pressure by 20% or more in 73% of eyes in the study.

The bent ab interno needle goniectomy (BANG) procedure may offer an alternative to more expensive glaucoma treatments, according to a study published in the Journal of Ophthalmic & Vision Research. At 6 months, the intraocular pressure (IOP)-lowering effect of the technique seems comparable to similar procedures that use a specialized blade, according to the report.  

Researchers developed a technique for BANG using a standard disposable 25-gauge hypodermic needle. They conducted a retrospective chart review for patients who underwent goniotomy using the modified hypodermic needle between July 2017 and June 2018, and included 41 eyes from 23 patients (mean age 76.6±7.7 years, 12 women) in the analysis. The team performed the BANG procedure alone (2 eyes) or combined with phacoemulsification (39 eyes). Mean intraocular pressure (IOP) was 17.4±4.1 mmHg and patients took a mean 1.1±1.4 topical glaucoma medications at baseline. 

A 6-month postoperative analysis revealed reductions in mean IOP and the number of topical glaucoma medications used (13.3±2.5 mmHg and 0.5±0.8, respectively; P ≤.01 for both). In 73% of patients, investigators noted a reduction in IOP of 20% or greater. A total of 73% of patients required no medications for IOP control and 41% achieved an IOP of 12 mmHg or less.

“The BANG procedure is a low-cost [microinvasive glaucoma surgery] technique available to surgeons around the world with preliminary outcomes similar to more expensive alternatives,” according to the researchers. “Similar procedures using a specialized blade have been shown to decrease IOP up to 26.2% over 12 months. While longer follow-up is needed, the IOP-lowering effect of the BANG appears comparable at six months.”

Study limitations include a small sample size, retroscopic nature, and convenience sampling.


Shute T, Green W, Liu J, Sheybani A. An alternate technique for goniotomy: description of procedure and preliminary results. J Ophthalmic Vis Res. 2022;17(2):170-175. doi:10.18502/jovr.v17i2.10787