Argon-laser gonioplasty following goniosynechialysis.

We performed laser gonioplasty following goniosynechialysis on 12 eyes that exhibited a very narrow angle. In these cases, angle closure had recurred postoperatively, although gonioscopy carried out at the time of goniosynechialysis revealed opening of the trabecular meshwork. The use of laser gonioplasty following goniosynechialysis was most effective in flattening the configuration of the iris and opening the iridocorneal angle. The induced alteration of the structure of the iris remained unchanged in all cases throughout the follow-up period, and intraocular pressure remained below 20 mmHg in 9 of the 12 eyes. It thus appears that a combination of goniosynechialysis and laser gonioplasty may be effective in the management of refractory angle-closure glaucoma in the presence of an extremely narrow angle.