Goniosynechiolysis

Description of Procedure:

Prior to the date of surgery, the risks, benefits, and alternatives of the planned procedure were discussed with the patient, and informed consent was obtained. The patient was identified in the preoperative area by the attending physician, and the operative eye was marked. The patient was taken to the operative suite and given IV sedation and topical ocular anesthesia. The operative eye was prepped and draped in the usual sterile ophthalmic fashion. A lid speculum was inserted.

A paracentesis was made into clear cornea. Lidocaine and viscoelastic were injected into the anterior chamber. A clear corneal incision was made using a keratome. Viscoelastic was injected onto the cornea. The patient’s head was rotated 35 degrees away from the surgeon, and the operating microscope was rotated 35 degrees toward the surgeon. A direct gonioprism was used to visualize the angle. Extensive peripheral anterior synechiae were noted. Additional viscoelastic was injected into the angle to break the synechiae. MST forceps were used to gently pull the iris to break residual synechiae, showing angle structures to scleral spur.

The patient’s head and the operating microscope were rotated back into neutral positions. The I/A handpiece was then used to remove residual viscoelastic. The corneal incision was hydrated with balanced salt solution then inspected with a Weck-cel sponge and found to be watertight with good intraocular pressure by finger tension. The speculum and drapes were removed, and antibiotic-steroid drops were placed in the eye. A patch and shield were applied. The patient was then transported to the postoperative care unit in good condition.