Endoscopically controlled goniosynechialysis in managing synechial angle-closure glaucoma.

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Management

Background:

• Glaucoma, particularly angle-closure glaucoma, often involves peripheral anterior synechiae.
• Goniosynechialysis (GSL) is a procedure to open these synechiae and improve aqueous humor outflow.
• Optimizing visualization during GSL is crucial for surgical success and minimizing complications.

Purpose of the Study:

• To present a novel surgical technique utilizing an ophthalmic microendoscope for enhanced visualization during goniosynechialysis (GSL).
• To evaluate the efficacy and safety of endoscopically controlled GSL in patients with angle-closure glaucoma or post-trabeculectomy complications.

Main Methods:

• Endoscopically controlled GSL was performed on twelve eyes of patients with acute angle-closure glaucoma or flat anterior chambers post-trabeculectomy.
• An ophthalmic endoscope was used for real-time visualization before, during, and after the GSL procedure.
• Outcomes assessed included intraoperative and postoperative complications, intraocular pressures (IOPs), and visual acuity.

Main Results:

• Mean follow-up was 7.4 months. Preoperative IOP averaged 42.89 mmHg, decreasing to 12.72 mmHg postoperatively.
• An absolute success rate (IOP < 21 mmHg without medication) was achieved in 80% of patients (8 of 10).
• Visual acuity improved in 91.7% (11 of 12) of patients, with no significant intraoperative complications reported.

Conclusions:

• The ophthalmic microendoscope provides surgeons with optimized visualization of the anterior chamber angle during GSL.
• This enhanced visualization facilitates greater accuracy and safety in performing goniosynechialysis.
• The technique shows promise for effectively managing glaucoma associated with peripheral anterior synechiae.