In cases where iris bombé presents alongside acute angle-closure glaucoma and cataract, definitive surgical management must address all three components: pupillary block, angle closure, and lens-induced crowding. Phacoemulsification combined with goniosynechiolysis is a highly effective approach in such scenarios.
Phacoemulsification reduces lens volume and deepens the anterior chamber, directly addressing the lens-induced component of angle closure. It also facilitates improved access to the peripheral iris and angle structures. Surgery begins with adequate preoperative IOP control using topical and systemic agents. Once corneal clarity is sufficient, a clear corneal incision is made, and the lens is removed using standard phacoemulsification techniques. Careful capsulorhexis and hydrodissection are essential, especially in shallow chambers.
Following lens extraction and intraocular lens implantation, goniosynechiolysis is performed. Using the IA probe with gentle suction peripheral anterior synechiae (PAS) are carefully dissected to reopen the angle. This step is crucial in restoring aqueous outflow and preventing chronic angle closure. In cases with extensive PAS, viscoelastic-assisted synechiolysis may also be employed to minimize trauma. In this video, before and after gonioscopic visualization demonstrates success.
Combined phacoemulsification and goniosynechiolysis provide both anatomical and functional restoration—deepening the anterior chamber, relieving pupillary block, and re-establishing trabecular outflow. This approach not only lowers intraocular pressure but also addresses the cataract, improving visual outcomes and reducing long-term glaucoma progression.
