Goniotomy with sodium hyaluronate

A modification of the classical goniotomy technique is described. After complete evacuation of the anterior and posterior chambers, sodium hyaluronate is placed in the anterior chamber and on the cornea. Putting hyaluronate in both locations prevents the formation of air bubbles under the goniotomy lens, provides the same index of refraction on both sides of the cornea, prevents accidental loss of the anterior chamber, and allows maximal depth of the anterior chamber. Diminished intraocular bleeding and lower risk of injury to the corneal endothelium, iris, and lens may be additional advantages of the procedure. Two cases are presented in which five goniotomies were performed on four eyes using this technique. Both patients had one eye controlled with a single goniotomy. The fellow eye of each patient required multiple procedures. Glaucoma was controlled successfully with no medication in all four eyes. No significant complications occurred.