Bent ab interno needle goniectomy (BANG) is an excisional trabecular minimally invasive glaucoma surgery (MIGS) technique that employs a modified hypodermic needle to remove a strip of trabecular meshwork via an ab interno approach, thereby enhancing aqueous outflow while preserving the conjunctiva. This article describes the surgical technique and perioperative considerations of BANG performed in a patient with a visually significant cataract, pseudoexfoliation, a poorly dilating pupil (4 mm), advanced primary open-angle glaucoma with a cup–disc ratio of 0.8:1, and uncontrolled intraocular pressure (36 mm Hg in both eyes), who could not afford conventional glaucoma surgery or implant-based MIGS. BANG was combined with temporal manual small incision cataract surgery in the right eye. Cataract extraction and posterior chamber intraocular lens implantation were followed by ab interno goniectomy using a bent 26-gauge needle under direct gonioscopic visualization to excise approximately 90° of nasal trabecular meshwork. On postoperative day 1, intraocular pressure in the operated eye reduced to 15 mm Hg on fewer topical medications. This conjunctiva-sparing, low-cost combined approach may be particularly useful in resource-limited settings and in patients with advanced glaucoma who are unlikely to adhere to intensive postoperative follow-up.
Ramani et al. (2026) studied this question.