Modern goniosynechialysis for the treatment of synechial angle-closure glaucoma.

A new and successful technique for goniosynechialysis is described. The essentials of the technique include: (1) use of the chamber deepening procedure to provide a wide, safe entrance to the angle; (2) use of sodium hyaluronate to hold the deepened configuration and to stop and localize bleeding, thus maintaining visibility; (3) use of an irrigating cyclodialysis spatula to hold the deepened chamber, to stop bleeding and to perform the lysis; and (4) direct visualization of the angle. Four cases with severe synechial angle closure of one year's duration or less were cured. An additional case of longer duration was significantly improved. The procedure should be considered for those patients who have developed significant synechial angle closure and high pressure, and in whom the synechiae have not been present for a prolonged period of time.