From the Guidelines
Goniotomy is not typically used to treat angle-closure glaucoma, and instead, laser peripheral iridotomy (LPI) is the preferred surgical treatment due to its favorable risk-benefit ratio 1. The primary goal in treating angle-closure glaucoma is to relieve the blockage of the drainage angle, which is typically achieved through LPI or other surgical interventions.
- Key considerations in the management of angle-closure glaucoma include:
- The use of medications such as beta-adrenergic antagonists, carbonic anhydrase inhibitors, and miotics to reduce intraocular pressure (IOP) and alleviate symptoms 1.
- The potential need for systemic hyperosmotic agents to rapidly decrease IOP in acute cases 1.
- The importance of timely treatment to prevent damage to the optic nerve, trabecular meshwork, iris, lens, and cornea 1. In contrast, goniotomy is a surgical procedure primarily used for congenital or infantile glaucoma, where the surgeon makes a small incision in the trabecular meshwork to improve aqueous humor outflow.
- The anatomical problem in angle-closure glaucoma is the position of the iris against the trabecular meshwork, not a developmental abnormality of the trabecular meshwork itself, making LPI a more effective treatment option 1. Medical management of angle-closure glaucoma typically includes medications like pilocarpine to pull the iris away from the angle, along with aqueous suppressants such as beta-blockers, alpha-2 agonists, or carbonic anhydrase inhibitors 1.
- In acute cases, osmotic agents like mannitol may be used to rapidly reduce intraocular pressure before definitive treatment with laser or surgery 1.
From the Research
Angle-Based Glaucoma Surgeries
Angle-based glaucoma surgeries, such as goniotomy, are procedures designed to treat glaucoma by improving the outflow of aqueous humor from the eye, thereby reducing intraocular pressure (IOP).
Goniotomy
- Goniotomy is a surgical procedure that involves making an incision in the trabecular meshwork, the spongy tissue located near the base of the iris, to improve the outflow of aqueous humor 2, 3, 4, 5.
- This procedure can be performed alone or in combination with other surgeries, such as phacoemulsification, to treat various types of glaucoma, including primary open-angle glaucoma and primary angle-closure glaucoma 2, 3.
- Goniotomy has been shown to be effective in reducing IOP and the number of glaucoma medications needed, with a low risk of complications 3, 4, 5.
Role in Treating Angle-Closure Glaucoma
- Goniotomy can be used to treat angle-closure glaucoma by improving the outflow of aqueous humor and reducing IOP 3, 5.
- The procedure can be performed as an adjunct to phacoemulsification, which involves the removal of the lens and implantation of an intraocular lens 3.
- Studies have shown that goniotomy can be an effective and safe treatment option for angle-closure glaucoma, with significant reductions in IOP and the number of glaucoma medications needed 3, 5.
Efficacy and Safety
- The efficacy and safety of goniotomy have been evaluated in several studies, which have shown that the procedure can be effective in reducing IOP and improving vision 2, 3, 4, 5.
- Common complications of goniotomy include hyphema, IOP spike, and corneal edema, but these are generally mild and temporary 3, 4, 5.
- Overall, goniotomy is a valuable treatment option for patients with glaucoma, particularly those with angle-closure glaucoma, and can be used alone or in combination with other surgeries to achieve optimal outcomes 2, 3, 4, 5.