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Editors Selection IGR 17-4
Surgical Treatment: Endoscopic goniosynechiolysis
Comment by Shan Lin on:
25116 Endoscopically controlled goniosynechialysis in managing synechial angle-closure glaucoma, Fang AW; Yang XJ; Nie L et al., Journal of Glaucoma, 2010; 19: 19-23
In their paper on endoscopically controlled goniosynechialysis (GSL), Fang et al. (523) describe their results in twelve patients (ten with history of acute angle-closure glaucoma and two with flat chamber after trabeculectomy). The success rate ‐ defined as IOP < 22 mmHg and no medications ‐ in those with a history of angle-closure glaucoma was 8/10. Preoperatively, all patients were on glaucoma medications and the overall mean pre-op IOP was 42.9 mmHg. All cases were combined with cataract surgery, mostly phacoemulsification; and GSL was attempted to clear all PAS. The authors demonstrated that endoscopy can be very effective in assisting GSL, producing excellent results in regard to IOP control and elimination of some or all PAS. Although gonioscopically controlled GSL is a reasonable alternative, the difficulty with its surgical approach and in cases of hazy cornea makes the endoscopic route a very favorable option. Potential disadvantages include the costs associated with the endoscopy unit, adaptation to two-dimensional viewing on a monitor, and the creation of additional incisions to accommodate the endoscopy probe. Also, it should be pointed out that recent studies have shown the effectiveness of phacoemulsification alone in controlling IOP in angle-closure eyes.1
In summary, this study is an excellent start for further evaluation of this technology in GSL. Larger series are needed including a possible prospective comparative trial versus gonioscopically controlled GSL or GSL without any direct visualization of the angle.
References
- Effects of phacoemulsification versus combined phaco-trabeculectomy on drainage angle status in primary angle closure glaucoma (PACG). Tham CC, Leung DY, Kwong YY, Li FC, Lai JS, Lam DS. J Glaucoma. 2010 Feb;19(2):119-23.
- Phacoemulsification versus combined phacotrabeculectomy in medically uncontrolled chronic angle closure glaucoma with cataracts. Tham CC, Kwong YY, Leung DY, Lam SW, Li FC, Chiu TY, Chan JC, Lam DS, Lai JS. Ophthalmology. 2009 Apr;116(4):725-31
- Phacoemulsification versus combined phacotrabeculectomy in medically controlled chronic angle closure glaucoma with cataract. Tham CC, Kwong YY, Leung DY, Lam SW, Li FC, Chiu TY, Chan JC, Chan CH, Poon AS, Yick DW, Chi CC, Lam DS, Lai JS. Ophthalmology. 2008 Dec;115(12):2167-2173.
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