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Endoscopic goniosynechiolysis for acute angle closure glaucoma following Descemet's stripping automated endothelial keratoplasty

Poster Details

First Author: M.Rana UK

Co Author(s):    P. Pandey   S. Shah   I. Masood        

Abstract Details

Purpose:

We describe a new modified technique to release the peripheral irido-corneal adhesions that are formed after descemet stripping automated endothelial keratoplasty(DSAEK) causing persistent raised intraocular pressure and early optic nerve damage.

Setting:

Birmingham and Midland Eye Centre

Methods:

A 84-year-old man known to suffer with Fuch’s endothelial dystrophy and primary open angle glaucoma underwent cataract surgery followed by a sequential endothelial keratoplasty (DSAEK). Due to intraoperative complications there was 360 degrees irido-corneal adhesions causing blockage of angular structures and Due to poor medical management, surgery was planned, where the commonly performed technique of goniosynechiolysis was modified and performed using endoscopic fiberoptic light and camera probe to aid visualization of the adherent iris tissue and carry out uneventful 270 degrees release of adhesions.

Results:

The blocked trabecular meshwork system was successfully re-canalized that allowed adequate control of intraocular pressure. The graft has survived the insult and cornea has gained complete clarity giving the patient the desired vision and improved quality of life

Conclusions:

As the DSAEK procedure is taking more precedence over the conventional penetrating keratoplasty due to various advantages including shortened healing times and fewer complications, we may find the incidence of this air-induced secondary glaucoma to rise. This new modified technique will help surgeons release the iridocorneal adhesions and help reduce spikes or persisted elevation of intraocular pressure. It will also reduce the risk of pressure induced optic neuropathy and graft failure. FINANCIAL DISCLOUSRE: NONE

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