Combined Phacoemulsification, Synechiolysis without Gonioprism Lens and Intracameral Tissue Plasminogen Activator Injection for Angle-Closure Glaucoma

PURPOSE: In this study we evaluated the safety and efficacy of combined phacoemulsification and synechiolysis without aid of gonioprism lens and intraoperative intracameral tissue plasminogen activator (tPA) injection for angle-closure glaucoma. METHODS: The method used in this study was synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection following cataract surgery. RESULTS: A total of 20 patients with a mean age of 71.4 +/- 5.4 years were treated. Mean follow-up time was 31.3 +/- 24.3 months. Mean preoperative and last visit intraocular pressures (IOPs) were 21.70 +/- 9.50 mm Hg and 12.40 +/- 2.30 mm Hg, respectively (p < 0.0001). The mean number of glaucoma medications decreased from 2.40 to 0.30 (p < 0.0001). IOP was maintained below 16 mm Hg in all cases. No significant intraoperative and postoperative complications, hyphema, or fibrin reaction occurred. CONCLUSIONS: Combined phacoemulsification and peripheral anterior synechiolysis with Kuglen hook without aid of gonioprism lens and intraoperative intracameral tPA injection is an effective and safe surgical procedure.

A Case of Anterior Synechiolysis with Lamellar Corneal Dissection in Penetrating Keratoplasty

PURPOSE: To report a case of anterior synechiolysis with lamellar corneal dissection in penetrating keratoplasty. CASE SUMMARY: In an eye with graft failure and anterior synechiae, we performed anterior synechiolysis with a healon needle after lamellar dissection using vacuum trephine to visualize the anterior chamber during penetrating keratoplasty. Additionally, the remnant corneal layer was removed using corneal scissors. A donor cornea was harvested using a vacuum trephine and the corneal button was sewn in place with 10-0 nylon. We observed a well grafted cornea and well formed anterior chamber with no anterior synechiae observed on follow-up. CONCLUSIONS: In patients with anterior synechiae, the cornea can be dissected from the anterior synechiae completely using lamellar corneal dissection in penetrating keratoplasty to visualize the anterior chamber.

Neodymium YAG Laser and Surgical Synechiolysis of Iridocapsular Adhesions

PURPOSE: Several articles have been published on the successful elimination of iridolenticular synechiae after cataract extraction with a neodymium YAG laser (Nd:YAG laser) and surgical synechiolysis during cataract surgery, but the indications recommending which method is proper to use for specific kinds of adhesions have not yet been established. METHODS: We retrospectively reviewed the medical records of 106 patients who had undergone Nd:YAG laser or surgical synechiolysis between January 2002 and December 2007 in our clinic. Laser synechiolysis was performed in the synechiae not exceeding the extent of one clock hour and reaching only to the iris sphincter, whereas surgical synechiolysis was performed in other diffuse and/or thick synechiae. RESULTS: Surgical synechiolysis was performed in 93 eyes, and YAG laser synechiolysis was done in 21 eyes. Increases in best-corrected visual acuity (BCVA) were observed in 61 eyes (53.51%). Intraocular pressure spikes after the procedure were present in only 4 eyes, and all of them were transient except for 1 eye, which needed additional glaucoma eyedrops. CONCLUSIONS: With suitable indications, laser or surgical synechiolysis can be performed safely, and a small rise in visual acuity may also be expected.

Clinical Effect of Nd -YAG Synechiolysis

Patients who had posterior synechiae associated with uveitis,IOL mplantation, vitrectomy, underwent Nd-YAG synechiolysis had been treated with topical corticosteroids and surgical iridectomy. Even minimal dilatation of the pupil by Nd YAG synechiolysis enable the patient to read and the surgeon to postpone cataract surgery and evaluate optic disc or fundus. Also, pupil block may be treated by detaching the synechiae.18 Patients (20 eyes) with posterior synechiae underwent Nd-YAG synechiolysis at Kangnam St.Mary's Hospital from November 1997 to August 1998. An average of 17.14 +/-6.43mJ laser were used. The average prelaser pupil size was 3.78 +/-0.98 mm ;postlaser, 5.13 +/-1.27 mm.This change was statistically significant (p<0.01). Microhyphema and pigment dispersion developed in 4 eyes. However,no significant long-term complications occurred, and there were no obvious lenticular damage and pupil abnormality. Because this laser treatment is relatively safe and offers some possibility of visual improvement, we recom-mend Nd-YAG synechiolysis,but only if performed by an experienced laser microsurgeon.