Endoscopically controlled goniosynechialysis in managing synechial angle-closure glaucoma.

Purpose: To propose a new surgical technique for optimized visualization of the chamber angle using ophthalmic microendoscope in goniosynechialysis (GSL).

Methods: Patients who had acute angle-closure glaucoma with peripheral anterior synechiae or patients with flat anterior chamber after trabeculectomy underwent endoscopically controlled GSL. Ophthalmic endoscope was used before, during, and immediately after GSL to minimize the procedure of GSL and to ensure that the trabecular meshwork was exposed and the majority of the angle was opened after endoscopically controlled GSL. Intraoperative complications, postoperative visual acuity, intraocular pressures (IOPs), and complications were all evaluated.

Results: Twelve eyes of twelve patients underwent the operation and the mean follow-up was 7.4+/-1.4 months (range: 6 to 10 mo). The mean preoperative IOP was 42.89+/-15.81 mm Hg. The mean postoperative IOP at the most recent follow-up was 12.72+/-3.48 mm Hg. The absolute success rate (IOP <21 mm Hg without medication) was 8 of 10. Visual acuity improved in 11 of 12 patients (91.7%). No significant intraoperative complications, such as iridodialysis, occurred in any patient. Postoperative complications included hyphema and transient corneal decompensation.

Conclusions: Endoscope conveniently provided the surgeon an optimized visualization of the anterior chamber angle. This enhanced visualization and convenience promises accuracy and safety when performing GSL.