Goniosynechialysis is a surgical procedure designed to address specific eye conditions. It involves the careful separation of abnormal adhesions within the eye’s drainage system. This procedure is performed to help manage intraocular pressure, which is the fluid pressure inside the eye.
What is Goniosynechialysis?
Goniosynechialysis directly targets synechiae, which are abnormal adhesions or fibrous bands that form between tissues inside the eye. The term “synechiae” originates from the Greek word “synekhes,” meaning “hold together.” These adhesions most commonly occur when the iris, the colored part of the eye, sticks to the cornea, the clear front part of the eye, or to the lens inside the eye. When the iris adheres to the cornea at the drainage angle, these are called peripheral anterior synechiae (PAS).
The eye continuously produces a clear fluid called aqueous humor, which normally drains out through a structure called the trabecular meshwork, located in the eye’s drainage angle. When peripheral anterior synechiae form, they can block this drainage pathway, interfering with normal outflow. This blockage can lead to an increase in intraocular pressure (IOP). Goniosynechialysis physically separates these adhesions, aiming to improve fluid outflow.
When is Goniosynechialysis Performed?
Goniosynechialysis is performed primarily to treat conditions where peripheral anterior synechiae (PAS) are obstructing the eye’s drainage angle, leading to elevated intraocular pressure. The most common condition necessitating this procedure is angle-closure glaucoma. In this form of glaucoma, the iris blocks the drainage pathway for the aqueous humor, causing pressure to build up inside the eye.
The procedure may be considered in cases of acute angle-closure glaucoma, where rapid relief of high intraocular pressure is needed to prevent optic nerve damage. It is also used for chronic angle-closure glaucoma when the angle closure is persistent or recurring. Goniosynechialysis can also be performed in conjunction with cataract surgery, especially when there is evidence of angle closure, allowing both conditions to be addressed simultaneously. The procedure is more effective when the synechiae have been present for a shorter duration, ideally less than one year.
The Goniosynechialysis Procedure
Preparation for goniosynechialysis includes a thorough consultation with an ophthalmologist to discuss the procedure and its benefits. Patients may receive specific eye drops and antibiotics before the procedure. Depending on the approach, patients may receive topical anesthesia, intravenous sedation, or general anesthesia.
During the procedure, a surgeon uses a surgical microscope and a gonio lens to get a clear view of the eye’s anterior chamber, specifically the drainage angle. A small incision is then made in the cornea to access this chamber. Using specialized microsurgical instruments, such as microforceps or a cyclodialysis spatula, the surgeon carefully separates the adhesions between the iris and the trabecular meshwork. This meticulous separation aims to widen the drainage angle, improving fluid flow. The procedure takes about 20 to 30 minutes.
Surgeons may use viscoelastic agents to help maintain the shape of the anterior chamber and aid in the separation of adhesions. The surgeon rotates the eye to access as much of the angle as possible. After the adhesions are separated, any remaining viscoelastic material is carefully removed, and the corneal incision is sealed.
After the Procedure: Recovery and Outlook
Following goniosynechialysis, post-operative care is important for a smooth recovery and to optimize the procedure’s effectiveness. Patients are prescribed eye drops, which may include antibiotics to prevent infection and anti-inflammatory medications to reduce swelling. It is important to adhere to the prescribed medication regimen carefully.
Patients may experience mild discomfort or blurry vision immediately after surgery. An eye shield is provided to protect the operated eye, particularly during sleep or activities that might cause accidental contact. Patients are advised to avoid rubbing the eye and to keep water out of it for approximately two weeks.
The goal of goniosynechialysis is to lower intraocular pressure and help prevent further damage to the optic nerve, thereby preserving vision. Regular follow-up appointments with the ophthalmologist are necessary to monitor intraocular pressure and overall eye health. While the procedure aims to restore normal fluid drainage, some patients may still require ongoing glaucoma management, including continued use of eye drops. Potential considerations include temporary fluctuations in intraocular pressure, mild to moderate inflammation, or minor bleeding. In some cases, adhesions may reform over time, which might necessitate additional treatments.