Goniosynechialysis for Lowering IOP in Primary Acute Angle-Closure Glaucoma

1. Yanhong Zou¹
2. Hanyi Min²
3. Xipu Liu^1,3

¹Department of Ophthalmology, First Hospital of Tsinghua University, Beijing, China
²Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
³Sekwa Eye Hospital, Beijing, China

PURPOSE: To evaluate the safety and intraocular pressure (IOP) lowering effect of goniosynechialysis in managing primary acute angle-closure glaucoma unresponsive to conventional medical therapy.

METHODS: Phacoemulsification with intraocular lens implantation was performed first if significant cataract was present. The goniosynechialysis technique involved deepening of the anterior chamber with balanced salt solution, injecting viscoelastic near the angle for 360 degrees without touching the trabecular meshwork to break the peripheral anterior synechiae (PAS), and mechanical goiosynechialysis with a special surgical instrument to physically break the PAS. Viscoelastic was removed and peripheral ididectomy was performed if lens remained.

RESULTS: In all, 15 eyes of patients with primary acute angle-closure glaucoma and greater than 270 degrees peripheral anterior synechiae (PAS) were treated. 11/15 patients need mechanical goniosynechialysis and 4/15 received cataract surgery at the same time. 14/15 patients showed exposure of the trabecular meshwork over 270 degrees examined just after the procedure and the angle remained open for 6 months except for 1 case who need trabeculectomy one month later. The Mean IOP reduced from 52.0 mmHg pre-operation to 15.3 mmHg at 6-months review. Among them, 8/14 patients were free of glaucoma medications. Localized minor bleeding in anterior chamber angle and temporary increase of IOP are the major complications during and after the procedure, respectively.

CONCLUSION: Goniosynechialysis may have a role in controlling IOP effectively and safely in patients with refractory angle closure glaucoma.