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Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae.

Mirshahi A, Raak P, Ponto K, Stoffelns B, Lorenz K, Scharioth GB - J Ophthalmol (2015)

Bottom Line: Results.No case required further glaucoma surgery.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Dardenne Eye Hospital, 53177 Bonn, Germany ; Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, 55131 Mainz, Germany.

ABSTRACT
Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS). Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated. Results. The mean preoperative intraocular pressure (IOP) was 20.3 ± 5.2 mmHg with 2.4 ± 1.0 medications. One year postoperatively, the mean IOP was 15.3 ± 3.3 mmHg (P = 0.004, paired t-test) with 0.6 ± 1.0 medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet's window rupture. Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS.

No MeSH data available.


Related in: MedlinePlus

Goniosynechiolysis ab interno using a spatula introduced through paracentesis. Full visual control is attained through the peripheral trabeculo-Descemet's window.
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fig1: Goniosynechiolysis ab interno using a spatula introduced through paracentesis. Full visual control is attained through the peripheral trabeculo-Descemet's window.

Mentions: The conjunctiva was opened carefully at the superior limbus using scissors. After minimal cauterization, a superficial scleral flap was created that reached far into the clear cornea. The superficial flap was sized 5 × 5 mm having a parabolic shape. The deep scleral flap had a triangular shape of approximately 3 × 3 × 3 mm. An incision of 2.8 mm width was made into the anterior chamber, and a tunnel was formed under the superficial flap. Phacoemulsification and IOL implantation were then performed. A deep scleral flap was prepared that was associated with an “unroofing” of Schlemm's canal and presentation of a “Descemet's window,” through which one could observe the anterior chamber and peripheral iris. Afterwards, the juxtacanalicular trabecular meshwork was peeled. The presence of peripheral anterior synechiae (goniosynechiae) in the surgical area usually prevents sufficient aqueous humor outflow, potentially leading to surgical failure. Under full visual control through the previously prepared “Descemet's window” (Figure 1), the anterior chamber was filled with air via paracentesis, followed by introduction of a fine iris spatula into the anterior chamber towards the surgical area. The air injection allows for stabilization of the anterior chamber. The inserted spatula is utilized to release the peripheral goniosynechia via a gentle swinging movement under direct visualisation through the trabeculo-Descemet's membrane. Air movement towards the iridocorneal angle, now open, confirmed successful goniosynechiolysis ab interno. The surgery was completed with the introduction of an implant (SK-Gel, T-Flux, or Healon GV) and watertight suturing of the superficial flap and conjunctiva. Further surgery was deemed necessary in the event that target IOP could be achieved with maximally tolerated medical therapy. Complete success was defined as IOP ≤21 mmHg without medication and qualified success with an IOP ≤21 mmHg with medication.


Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae.

Mirshahi A, Raak P, Ponto K, Stoffelns B, Lorenz K, Scharioth GB - J Ophthalmol (2015)

Goniosynechiolysis ab interno using a spatula introduced through paracentesis. Full visual control is attained through the peripheral trabeculo-Descemet's window.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4493305&req=5

fig1: Goniosynechiolysis ab interno using a spatula introduced through paracentesis. Full visual control is attained through the peripheral trabeculo-Descemet's window.
Mentions: The conjunctiva was opened carefully at the superior limbus using scissors. After minimal cauterization, a superficial scleral flap was created that reached far into the clear cornea. The superficial flap was sized 5 × 5 mm having a parabolic shape. The deep scleral flap had a triangular shape of approximately 3 × 3 × 3 mm. An incision of 2.8 mm width was made into the anterior chamber, and a tunnel was formed under the superficial flap. Phacoemulsification and IOL implantation were then performed. A deep scleral flap was prepared that was associated with an “unroofing” of Schlemm's canal and presentation of a “Descemet's window,” through which one could observe the anterior chamber and peripheral iris. Afterwards, the juxtacanalicular trabecular meshwork was peeled. The presence of peripheral anterior synechiae (goniosynechiae) in the surgical area usually prevents sufficient aqueous humor outflow, potentially leading to surgical failure. Under full visual control through the previously prepared “Descemet's window” (Figure 1), the anterior chamber was filled with air via paracentesis, followed by introduction of a fine iris spatula into the anterior chamber towards the surgical area. The air injection allows for stabilization of the anterior chamber. The inserted spatula is utilized to release the peripheral goniosynechia via a gentle swinging movement under direct visualisation through the trabeculo-Descemet's membrane. Air movement towards the iridocorneal angle, now open, confirmed successful goniosynechiolysis ab interno. The surgery was completed with the introduction of an implant (SK-Gel, T-Flux, or Healon GV) and watertight suturing of the superficial flap and conjunctiva. Further surgery was deemed necessary in the event that target IOP could be achieved with maximally tolerated medical therapy. Complete success was defined as IOP ≤21 mmHg without medication and qualified success with an IOP ≤21 mmHg with medication.

Bottom Line: Results.No case required further glaucoma surgery.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Dardenne Eye Hospital, 53177 Bonn, Germany ; Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, 55131 Mainz, Germany.

ABSTRACT
Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS). Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated. Results. The mean preoperative intraocular pressure (IOP) was 20.3 ± 5.2 mmHg with 2.4 ± 1.0 medications. One year postoperatively, the mean IOP was 15.3 ± 3.3 mmHg (P = 0.004, paired t-test) with 0.6 ± 1.0 medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet's window rupture. Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS.

No MeSH data available.


Related in: MedlinePlus