PubMed · 7777289
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M Wand. 1995. Laser iridotomy.. https://doi.org/10.1016/s0161-6420(95)30944-x
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PURPOSE: To compare the performance of the double-mirror goniolens with dual viewing system in goniosurgery, goniosynechialysis, and trabeculotomy ab externo with that of the conventional Swan-Jacob gonioprism (SJG). DESIGN: Prospective interventional case series. METHODS: We treated 10 patients (10 eyes) with medically uncontrollable chronic angle-closure glaucoma by goniosynechialysis and another 10 eyes with open-angle glaucoma by trabeculotomy ab externo (TLO). The 20 patients were divided randomly into two equal groups and underwent operation with the double-mirror goniolens or SJG instrument. RESULTS: There were no intraoperative complications, irrespective of the procedure or instrument that was used. Patients in the SJG group were required to tilt the head at a >30-degree angle to facilitate observation and manipulation of the quadrants. On the other hand, all structures could be observed and manipulated without head-tilting in the double-mirror goniolens group. CONCLUSION: The double-mirror goniolens with dual viewing system is more suitable than the conventional SJG for goniosurgery.
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Pupillary block is probably the underlying mechanism in most cases of angle closure. Laser iridotomy is the technique of choice for managing primary angle closure due to pupillary block. In some cases laser iridotomy does not physically eliminate appositional angle closure because mechanisms other than pupillary block are present. In other cases the mechanism of angle closure is not intermittent (appositional) but permanent (synechial). Iridoplasty is a simple and effective means of opening an appositionally closed angle. Lens extraction is often sufficient and advisable when cataract is present, followed if necessary by goniosynechialysis. Trabeculectomy can always be done later and more safely (30%). However, malignant glaucoma (ciliary block) may complicate trabeculectomy in cases with primary angle closure.