Article Text

PDF
Viscogonioplasty in patients with chronic narrow angle glaucoma
  1. D Varma,
  2. W E Adams,
  3. P S Phelan,
  4. S G Fraser
  1. Sunderland Eye Infirmary Queen Alexandra Road Sunderland SR4 9HP, UK
  1. Correspondence to: MrScott Fraser Sunderland Eye Infirmary Queen Alexandra Road Sunderland SR4 9HP, UK; sfraser100{at}totalise.co.uk

Statistics from Altmetric.com

Chronic narrow angle glaucoma (CNAG) occurs when the anterior chamber drainage angle progressively narrows with a subsequent rise in intraocular pressure (IOP) and, if this rise is maintained, glaucomatous optic neuropathy. Although there may be a number of reasons for this narrowing, if the peripheral iris remains apposed to the trabecular meshwork for any length of time it is likely that a more permanent adhesion occurs (PAS). Thus even though the underlying cause for the narrowing is removed—for example, pupillary block after peripheral iridectomy (PI) or cataract extraction in lens induced disease, the angle remains closed and the IOP remains damagingly high.

We have previously described a technique for use in acute angle closure glaucoma where the lens induced narrowing is removed by cataract extraction and the PAS broken with viscoelastic. This manoeuvre has been called viscogonioplasty (or VGP).1 This case series describes the results of this same technique in patients with chronic narrow angle glaucoma

Case series

From April 2002 to March 2005 all patients with CNAG inadequately controlled on conventional therapy were enrolled. The inclusion criteria were as follows:

  • Occludable angle confirmed by gonioscopy

  • Evidence of uncontrolled IOP (raised IOP, progressive glaucomatous optic neuropathy, and/or visual field progression)

  • Previous patent PI.

An occludable angle was defined as the angle in which the posterior (usually pigmented) trabecular meshwork was seen for less than 90° of the angle circumference.2

Exclusion criteria included:

  • Plateau iris syndrome

  • Previous glaucoma surgery (argon laser trabeculoplasty/trabeculectomy)

  • Retinal disease

  • History of ocular injury

  • Other glaucomas.

The duration of increased IOP or synechial angle closure was not one of our inclusion or exclusion criteria. However, all patients …

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.