Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet's Stripping Automated Endothelial Keratoplasty

Abstract

We describe a new modified technique to release the peripheral iridocorneal adhesions that formed after Descemet stripping automated endothelial keratoplasty. The usual technique of goniosynechialysis was modified and performed using endoscopic fiber-optic light and camera probe to aid visualization of the adherent iris tissue and carry out uneventful 270 degrees release of adhesions. The iris tissue was gently pulled away using micro forceps. The modified technique was conceptualized, as the view from the cornea was very poor due to recent lamellar surgery and corneal oedema secondary to poorly controlled intraocular pressure. The blocked trabecular meshwork system was successfully recanalized, which allowed an adequate control of intraocular pressure. The graft survived the insult and cornea gained complete clarity giving the patient the desired vision and improved quality of life. How to cite this article: Rana M, Shah S, Pandey P, Masood I. Endoscopic Goniosynechialysis for Acute Angle Closure Glaucoma Following Descemet's Stripping Automated Endothelial Keratoplasty. J Curr Glaucoma Pract 2018;12(2):90-93.

Keywords: Educational training; Glaucoma; Resident versus attending; Tube shunt surgery; Cohort study.

Fig. 1A to D:

(A) and (B) Ultrasound biomicroscopy showing extensive peripheral anterior synechiae post endothelial keratoplasty causing obstruction of aqueous outflow resulting in persistent uncontrolled intraocular pressure; (C) and (D) Ultrasound biomicroscopy done after GSL shows release of peripheral anterior synechiae and an open trabecular meshwork space, which allowed adequate IOP control.

Figs 2A to D:

(A) MVR blade used to make 2 paracentesis incisions; (B) Endoscopic fiberoptic light probe with an attached camera and a small micro-holding forceps inserted through the paracentesis; (C) and (D) Micro-holding forceps used to grasp the anterior iris close to the synechiae and pulled to release the adhesions