Trabeculectomy and Surgical Peripheral Iridectomy With Goniosynechialysis and Goniotomy in PACG

How trabeculectomy and alternative surgical procedures are performed to treat advanced primary angle-closure glaucoma.

Primary angle-closure glaucoma (PACG) is a prevalent form of glaucoma, accounting for 50% of glaucoma-related blindness worldwide. Trabeculectomy is usually highly effective in managing PACG, particularly in its advanced stages. Nevertheless, potential complications like shallow anterior chamber, persistent hypotony, malignant glaucoma, endophthalmitis, bleb-related issues, and challenges in postoperative care can diminish its suitability. This randomized trial aimed to assess the efficacy and safety of surgical peripheral iridectomy (SPI) plus goniosynechialysis (GSL) and goniotomy (GT) vs trabeculectomy for advanced PACG without cataract. A, This video demonstrates the procedure of trabeculectomy for a patient with advanced PACG without cataract. A corneal limbus incision was made between the 11-o’clock and 1-o’clock positions to raise a fornix-based conjunctival flap. A scleral flap (4 × 3 mm; one-half thickness) was lifted and treated with mitomycin, 0.4 mg/mL, for 2 minutes underneath. Subsequently, a trabecular block measuring about 1 × 2 mm was excised followed by SPI over a 1.5 × 1.5-mm area. The scleral flap was then repositioned and sutured using two 10-0 nylon stitches and the bulbar conjunctiva closed with 10-0 interrupted sutures. B, This video demonstrates the procedure of SPI with GSL and GT for a patient with advanced PACG without cataract. SPI was conducted initially in the superior-nasal quadrant. Subsequently, a 2.2-mm main corneal incision was made temporally. GSL was executed 120° using a chopper. A microhook (Tanito Microhook; Inami & Co) was inserted through the corneal incision, with the tip implanted into the Schlemm canal. This allowed for scratching and incising the inner walls of the Schlemm canal and the trabecular meshwork across a range of 120°. Click ja.ma/4cpFNxk for full details.