Viscogonioplasty: an effective procedure for lowering intraocular pressure in primary angle closure glaucoma

Abstract

Purpose To evaluate the safety and intraocular pressure (IOP) lowering effect of combined phacoemulsification and viscogonioplasty (Phaco-VGP) in managing primary acute closed-angle glaucoma (ACAG) unresponsive to conventional therapy (patent PI). Patient and Methods In all, 15 consecutive eyes of patients with refractory ACAG and greater than 2701 peripheral anterior synechiae (PAS) underwent VGP. The technique of VGP involved routine phacoemulsification with intraocular lens implantation (Phaco/IOL) under topical anaesthetic. Following IOL implantation a heavy viscoelastic was used to deepen the anterior chamber and then injected near the angle for 3601 (without touching the trabecular meshwork) to break the PAS. No surgical instrument was used to physically break the PAS. Upon completion of VGP, automated irrigation with balanced salt solution to remove the viscoelastic was performed. Results Mean IOP reduced from 52.1 to 14.1 mmHg by Phaco-VGP at 6-months review. 14/15 patients were free of glaucoma medications at 6-month review. All angles showed exposure of the trabecular meshwork over 3601 postoperatively without evidence of residual synechiae. No untoward complications were observed in any patient. Conclusion VGP may have a role in controlling IOP effectively and safely in patients with refractory ACAG. It produces a large drop in the IOP and opening of the angle. It is a relatively simple technique to learn and we would recommend its use in the eyes of all patients who have had ACAG and are undergoing cataract extraction.

Combined phacoemulsification and viscogoniosynechialysis in patients with refractory acute angle-closure glaucoma

“…In patients with more than 270 degrees of closed angle, medical therapy is usually unsuccessful and surgical intervention becomes necessary. 7 Elimination of PAS and the possible return of trabecular function before irreversible structural changes occur is a reasonable approach to the treatment of ACG. Goniosynechialysis has been described as a procedure to separate PAS; it is effective in patients with PAS that has been present for fewer than 6 to 12 months.…”

“…The mean follow-up after surgery was 11.7 months. Varma et al 7 report a high success rate for phacoemulsification and synechialysis using an OVD (viscogonioplasty) in patients with primary ACG. The mean IOP was reduced from 52.1 to 14.1 mm Hg, and 14 of the 15 patients were on no antiglaucoma medication postoperatively.…”

“…In the study by Varma et al, 7 patients received oral acetazolamide (250 mg) 4 times a day for 24 hours and the IOP on the first postoperative day was not reported.…”

“…1 Trabeculectomy in acute ACG is, however, is associated with potentially serious complications such as a shallow or flat anterior chamber, malignant glaucoma, suprachoroidal hemorrhage, and endophthalmitis. 2 Recently, lens extraction with posterior chamber intraocular lens (IOL) implantation 3,4 and phacoemulsification with goniosynechialysis, [5][6][7] have been shown to successfully lower the IOP in patients with uncontrolled angle-closure glaucoma (ACG). These procedures may have advantages over trabeculectomy.…”

Guía terapéutica del glaucoma crónico por cierre angular primario

“…Dado que no se utiliza ningún instrumento quirúrgico para romper la SAP, se reduce el riesgo de complicaciones, como hemorragias o daño en el ángulo. En dos estudios de series de casos prospectivos y un ensayo clínico aleatorizado, Varma et al han mostrado su efectividad en la reducción de PIO en pacientes con GCCAP con iridotomía patente y no controlados médi-camente, pero no mencionan la cantidad de SAP antes y después de la cirugía y no reportan los detalles de los hallazgos gonioscópicos 79,109,110,79 .…”