Phacoemulsification combined with intraocular lens implantation plus goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma

Phacoemulsification combined with intraocular lens implantation plus goniosynechialysis and goniotomy for advanced primary angle-closure glaucoma

The surgery was performed by Prof. Chen Weirong and Prof. Zhang Xiulan from Zhongshan Ophthalmic Center of Sun Yat-sen University. The right eye of patient received the operation.

The phacoemulsification combined with intraocular lens implantation was finished by Prof. Chen. A main 2.2 mm transparent corneal incision was made on the temporal side of the right eye, and the lateral incision was made on the superior. The anterior chamber was injected with viscoelastic, then the continuous circular capsulorhexis, water separation, the cataract nucleus removed by phacoemulsification, and the lens cortex removed with suction. After the anterior chamber was injected with viscoelastic, a one-piece intraocular lens was implanted, and the viscoelastic was injected into the anterior chamber and the nasal anterior chamber to deepen the anterior chamber and maintain a certain degree of corneal stiffness.

Goniosynechialysis and goniotomy were performed by Prof. Zhang. The patient’s head was adjusted to the nasal side of the right eye at an angle of about 40°, and the operating microscope was adjusted to the temporal side of the right eye at an angle of about 30° to give the operator a better view. The viscoelastic was applied to the corneal surface to provide a better view of the nasal anterior chamber angle with a gonioscope, which showed that the left anterior chamber angle was open and the right one was closed. The anterior chamber angle was separated by light pressure on the iris  with a nucleus dividing hook to see the lower 2/3 of the functional trabecular meshwork and the crest of sclera. The Tanito ab-interno Trabeculotomy Micro-hook reached Schlemm canal via the anterior wall of trabecular meshwork, and made Schlemm canal incision of approximately 60° to the left and right, respectively, for a total incision of approximately 120°.

The operative eye and microscope were adjusted to normal position. Prof. Chen completed the viscoelastic aspiration of anterior chamber and formed the anterior chamber.

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