15yo one-eye patient with small anterior segment, history of ROP, referred to me for advanced chronic angle closure glaucoma, 360 degrees of PAS with IOP 35mmHg on maximum meds and oral Diamox. Biometry: 21.24mm AL, 2.25mm ACD, 4.64mm LT, 10.4mm WTW. Premise here is to avoid bleb surgery and manage the angle. Some element of weak zonules (associated with ROP, and a cause of angle closure), managed with lensectomy and CTR. Goniosynechialysis, goniotomy and iStents used to enhance physiological outflow. Iridozonulohyaloidectomy performed to create unicameral eye to prevent/treat malignant glaucoma (high risk here). Three months postop, IOP was 8mmHg on 3 meds.
The video by Ike Ahmed
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