Ensure visibility, use enough viscoelastic when performing goniotomy
Click Here to Manage Email Alerts
NEW ORLEANS — Ensuring adequate visualization and using proper pressure and viscoelastic are important aspects of achieving success when performing a goniotomy procedure, according to a speaker here.
“When we’re talking about goniotomy these days, this isn’t our grandparents’ goniotomy,” Leonard K. Seibold, MD, said at Glaucoma Subspecialty Day at the American Academy of Ophthalmology meeting. “Modern-day goniotomy looks a lot different thanks to some modern-day innovation that allows us to not only incise but excise trabecular meshwork tissue.”
Seibold’s first pearl for performing goniotomy is to ensure proper visualization.
“We harp on this a lot in the MIGS space — it’s visualization. I think it’s very key for this procedure. You want to ensure an en face view,” Seibold said.
Use viscoelastic or another cohesive agent to keep the view, and if the view begins to slip during the procedure, Seibold recommended stopping and refilling the eye.
When beginning the procedure, Seibold said to tilt the blade up 10° to 20° and apply “moderate” outward pressure to pierce the meshwork.
“Then you want to relax and glide in the angle,” he said. “If you’re coming out as you proceed, you need to add a little more pressure to keep that footplate seated in the canal.”
In addition, it is helpful to use the incision as a fulcrum.
“You want to float or pivot in the wound, and this will allow you to follow the contour of the angle. The angle isn’t a straight line, so you need to be constantly adjusting,” Seibold said.
“I think [goniotomy’s] biggest strong suit is it has the greatest versatility in this space. You can treat any disease severity, any lens status. You’re augmenting that conventional outflow pathway,” he said.
Collapse
Seibold LK. Goniotomy: Ideal patient and key pearls for success and why I didn’t do the other MIGS. Presented at: American Academy of Ophthalmology meeting; Nov. 12-15, 2021; New Orleans.
Read more about
Click Here to Manage Email Alerts