Our guest surgeon Professor Ramesh Ayyala is a renowned expert surgeon for complex anterior segment cases and in this video he shows a compilation of acute glaucomas that he treats and fixes at the slit lamp. The fellowship that he offers is amazing and you should highly consider it.
Acute angle-closure glaucoma demands urgent intervention to rapidly reduce intraocular pressure (IOP) and prevent optic nerve damage. When medical therapy alone is insufficient, anterior chamber paracentesis at the slit lamp using a 30-gauge needle provides immediate pressure relief. After topical anesthesia, a sterile 30-gauge needle on a tuberculin syringe is inserted through the peripheral cornea, usually at the 3 or 9 o’clock position, carefully avoiding the lens and iris. Gentle aspiration of 0.1–0.3 mL of aqueous humor lowers IOP and alleviates corneal edema. In eyes with peripheral anterior synechiae, the same needle can be used to perform gonio-synechiolysis: under gonioscopic visualization, the needle tip is used to mechanically release synechial adhesions between the peripheral iris and trabecular meshwork, reopening the angle. Extreme care is required to avoid trauma to the iris, lens, or corneal endothelium. After the procedure, IOP-lowering medications are continued, and definitive therapy, such as laser peripheral iridotomy or cataract extraction, is planned.
