| |
Step |
Descriptor |
Points To Note |
| Pre-Op |
1 |
Office Based Gonioscopy |
Essential for surgical planning. Is angle open or closed? |
| 2 |
Angle Anatomy |
Scleral spur–anatomic landmark separates canal based from supra choroid surgery |
| 3 |
Anesthesia |
Peri- or retrobulbar block vs. topical |
| Intra-operative |
Extra-Ocular |
4 |
Head/Microscope Rotation |
Alignment of coaxial light along axis of iris plane |
| 5 |
Goniolens Selection |
Modification of Swan Jacob Lens. Handle contiguous with goniolens. |
| 6 |
Hand positioning |
Holding and positioning lens with non-dominant hand to optimize viewing |
| Intra-Ocular |
7 |
Corneal Incision |
Eccentricity and location avoid interference between instruments and goniolens. Incision along 3 and 9 o’clock plane provides pivoting and equidistant access to superior and inferior nasal angles |
| 8 |
Soft Shell Technique |
Dispersive OVD protects endothelium. Cohesive OVD creates and maintains angle space |
| 9 |
Goniolens Docking & Manipulation |
Global corneal stimulation of sub-epithelial corneal nerves. Consider Lidocaine as coupling Gel.
Fixation ring provides globe control and rotation in x and z direction during surgery |
| Post-Op |
|
10 |
Gonioscopy Goniophotography |
To build surgeon and patient confidence. Useful for documentation and pre-op counseling |
