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.

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“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