Our CataractCoach Podcast guest yesterday was Dr Deborah Ristvedt and we learned how she brings a wide range of surgical expertise to her patients, including glaucoma procedures. In this case, she has a pseudophakic patient with extensive synechiae at the pupil margin and also in the angle. She uses a gonioscopic view to lyse these synechiae and help restore aqueous outflow to keep the intra-ocular pressure under control. What is your approach to cases like this?
This looks like a case of pupillary block glaucoma in a pseudo phakic eye due to iris bombe. Releasing the PS and pulling gently at the iris 360 degrees like you do and a PI for extra effect would relieve the pupillary block and essentially the secondary glaucoma. The surgeon here using a direct gonioscope does a beautiful job which needs practice.