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Goniosynechialysis can help manage specific angle-closure cases
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BEIJING — Goniosynechialysis is indicated in chronic angle-closure glaucoma patients who cannot undergo trabeculectomy, have had failed filtration surgery or have extensive peripheral anterior synechiae, a speaker said here.
Jimmy Lai, MD, spoke about the role of goniosynechialysis (GSL) in glaucoma surgical treatment at the 25th APAO Congress. He said the procedure can be an option, especially in those cases that are at high risk for failure during, or in the postoperative care of trabeculectomy. Patients with significant peripheral anterior synechiae and poor hygiene are also good candidates for GSL, he said. However, they should not have advanced cup-to-disc ratios.
"GSL may still have a limited role in the surgical management of [chronic angle-closure glaucoma]," Dr. Lai said.
Studies have shown that the angle opens following the procedure, with an 80% success rate if peripheral anterior synechiae have been present for less than 1 year. It is best performed in phakic and pseudophakic eyes, combined with other procedures and following filtration surgery, he said.
"GSL is basically an outflow reconstruction surgery. It releases the mechanical obstruction of the trabecular meshwork. It results in the rapid lowering of intraocular pressure," Dr. Lai said.
Success of the procedure is focused on trabecular function, with duration of angle closure and maintenance of the opened angle, he said.
The procedure has good results when combined with cataract surgery, including no overdrainage or suprachoroidal hemorrhage. However, there are disadvantages to combining the procedures, including the potential for high intraoperative IOP and postoperative IOP spike, Dr. Lai said.