Intra-operative gonioscopy: a key to successful angle surgery

Abstract

Since its inception, gonioscopy has been primarily utilized for angle assessment, laser trabeculoplasty and surgery limited to the pediatric age group. Three-fourths of a century would pass since Barkan’s description of goniotomy before intra-operative gonioscopy would come into vogue with the advent of micro-invasive glaucoma surgery. Over the last decade, several clinical trials have been conducted or are currently underway in evaluating devices and instruments targeting different surgical spaces within the angle. However, a rate-limiting step of successful angle surgery requires good gonioscopy and has led to a renewed interest among ophthalmologists to master this skill. During this same time period, several goniosurgical lens prototypes have been introduced in the market with the goal of optimizing angle viewing including clarity, globe stability, accessibility and simultaneous surgical manipulation of angle structures. Several non-gonioscopic methods have also been recently introduced to facilitate angle surgery.

Keywords::

• angle surgery
• anterior chamber angle
• goniolens
• gonioscopy
• micro-invasive glaucoma surgery

Financial & competing interests disclosure

I Ahmed has been a consultant for Alcon, AMO, Aquesys, Glaukos, Ivantis and Transcend. S Vold has been a consultant for and receives research support from Transcend Medical. All royalties from the Transcend Vold Gonio Lens are donated to the Glaucoma Research Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.

Key issues

• Historically, gonioscopy has been utilized primarily for angle assessment, trabeculoplasty and goniotomy.

• With the advent of micro-invasive glaucoma surgery (MIGS), more than three-fourths of a century after Barkan’s description of goniotomy, intra-operative gonioscopy has come into vogue expanding beyond the pediatric age group with a renewed interest among ophthalmologists to master this technique.

• Several MIGS clinical trials have been introduced in the last decade focusing on different target surgical spaces within the angle.

• The key to successful MIGS surgery requires good gonioscopy. This has led to a parallel introduction and commercialization of several surgical goniolenses to optimize angle visualization with a focus on clarity, globe stability, instrument accessibility and simultaneous surgical manipulation of delicate angle structures.

• Non-gonioscopic methods have recently been introduced to facilitate angle surgery.

Notes