PMC7674794_01
Pre-operative examination of both eyes. (A) Anterior segment picture of the right eye (RE) shows posterior synechiae, peripheral iridotomy, and cataractous lens. (B) Slit-lamp examination of the left eye shows narrow anterior chamber. (C) Anterior segment-optical coherence tomography of the RE shows a closed iridocorneal angle.
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Ocular examination of the RE revealed conjunctival hyperemia, corneal edema, shallow anterior chamber, posterior synechia, mid-dilated non-reactive pupil, and early cataractous changes (Figure 1A). Anterior segment examination findings in the LE were normal, except for a shallow anterior chamber (Figure 1B). Ultrasound biomicroscopy (UBM) reported a 360  closed-angle with no signs suggesting the diagnosis of plateau iris configuration, and anterior segment optical coherence tomography (AS-OCT) showed a closed iridocorneal angle (Figure 1C).
Intra-operative pictures of the surgical procedures. (A) MicroPulse transscleral laser therapy using the Cyclo G6 laser system. (B) Kahook Dual Blade (KDB) assisted goniosynechialysis. (C) KDB-assisted excisional goniotomy. (D) Removal of ophthalmic viscoelastic device and blood reflux with irrigation/aspiration.
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Xylocaine gel was applied over 360  of the conjunctiva prior to treatment (Figure 2A). KDB was then inserted through the main corneal incision and advanced toward the nasal angle; GSL was performed and the footplate of KDB was used to disrupt the PAS and expose the TM for KDB-assisted goniotomy, in which the pointed tip of the KDB was advanced to engage and excise a strip of TM. (Figure 2B and C). The microscope and the patient's head were rotated to their original position, and the viscoelastic and blood reflux from Schlemm's canal was removed from the eye using the irrigation/aspiration handpiece (Figure 2D).
Post-operative examination of the right eye (RE). (A) Post-operative slit-lamp examination of the RE shows deep anterior chamber with a clear cornea, and intraocular lens in place. (B) Post-operative anterior segment-optical coherence tomography of the RE shows deep anterior chamber with surgically created cleft in the trabecular meshwork (arrow).
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Slit-lamp examination revealed a clear cornea with a deep anterior chamber (Figure 3A). Post-operative AS-OCT of the RE revealed a deep anterior chamber with a surgically created cleft in the TM (Figure 3B).