Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae

Alireza Mirshahi; Peter Raak; Katharina Ponto; Bernhard Stoffelns; Katrin Lorenz; Gábor B Scharioth

doi:10.1155/2015/625719

Deep Sclerectomy with Goniosynechiolysis Ab Interno for Chronic Glaucoma Associated with Peripheral Anterior Synechiae

J Ophthalmol. 2015:2015:625719. doi: 10.1155/2015/625719. Epub 2015 Jun 23.

Authors

Alireza Mirshahi¹, Peter Raak², Katharina Ponto³, Bernhard Stoffelns³, Katrin Lorenz³, Gábor B Scharioth⁴

Affiliations

¹ Dardenne Eye Hospital, 53177 Bonn, Germany ; Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, 55131 Mainz, Germany.
² Aurelios Eye Center, 45657 Recklinghausen, Germany.
³ Department of Ophthalmology, University Medical Center, Johannes Gutenberg-University, 55131 Mainz, Germany.
⁴ Aurelios Eye Center, 45657 Recklinghausen, Germany ; Department of Ophthalmology, University of Szeged, Szeged 6720, Hungary.

Abstract

Purpose. To report one-year results of phacoemulsification combined with deep sclerectomy and goniosynechiolysis ab interno for chronic glaucoma associated with peripheral anterior synechiae (PAS). Methods. We retrospectively analyzed medical charts of 16 patients (20 eyes) treated by one-site combined phacoemulsification and deep sclerectomy with goniosynechiolysis ab interno. PAS were transected by a spatula introduced into the anterior chamber through a paracentesis. To account for the correlation of right and left eyes a linear mixed model with unstructured covariance structure was calculated. Results. The mean preoperative intraocular pressure (IOP) was 20.3 ± 5.2 mmHg with 2.4 ± 1.0 medications. One year postoperatively, the mean IOP was 15.3 ± 3.3 mmHg (P = 0.004, paired t-test) with 0.6 ± 1.0 medications. A postoperative IOP of ≤21 mmHg without medication was achieved in 17 of 19 eyes (89.5%) and in 12/19 eyes (63.2%) at 3 and 12 months after surgery, respectively. In the remaining eyes (10.5% at 3 months and 36.8% at 12 months), additional medication led to an IOP ≤21 mmHg or the target pressure. No case required further glaucoma surgery. In one eye, conversion of the surgery to trabeculectomy was necessary due to Descemet's window rupture. Conclusions. With goniosynechiolysis ab interno, effective and safe nonpenetrating glaucoma surgery is possible in presence of PAS.