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Angle Surgery: Goniotomy

  • David S. Walton
  • Elizabeth Hodapp
Chapter

Abstract

Goniotomy became the procedure of choice for primary congenital glaucoma (PCG) when Otto Barkan reported on its surgical success in 1942, and PCG remains the most common indication for goniotomy as of this writing. This chapter reviews the indications for surgery, preoperative preparation, operative technique, postoperative management, complications, and results of goniotomy. Its goal is to describe the position of goniotomy in the current surgical armamentarium of procedures for glaucoma. It is not intended to replace direct, personal training for individuals who want to perform the procedure.

Keywords

Angle surgery Goniotomy Primary congenital glaucoma Goniosurgery Sturge-Weber syndrome Apraclonidine 

Supplementary material

Video 4.1

Nasal goniotomy technique, shown using locking forceps at the superior and inferior limbus, and a Barkan goniotomy lens modified with the addition of a handle, sitting on a cushion of viscoelastic applied to the cornea. A 25-gauge needle is used to enter the anterior chamber and to make a cleft to either side, while the assistant stabilizes the globe and rotates it to expose additional angle. Note that the needle entry is closed with a single buried10-0 polyglactin suture. (Courtesy of Sharon F. Freedman, MD) (WMV 7359 kb)

Video 4.2

Nasal goniotomy technique without traction suture or assistant using modified Swan-Jacob lens. The anterior chamber is maintained with viscoelastic and a 25-gauge needle. (Courtesy of Alana Grajewski, MD) (MP4 67175 kb)

Video 4.3

Nasal goniotomy without an assistant using a standard Swan-Jacob lens and a 25-gauge needle on viscoelastic. (Courtesy of and narrated by Elizabeth Hodapp, MD) (MOV 6983 kb)

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Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of OphthalmologyMassachusetts Eye and Ear InfirmaryBostonUSA
  2. 2.Bascom Palmer Eye Institute, Department of OphthalmologyUniversity of Miami Miller School of MedicineMiamiUSA

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