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Goniosynechialysis (GSL)

Goniosynechialysis (GSL) is a surgical technique that involves separation of the peripheral anterior synechiae, adhesions that occur in the corners of the eyes. It is done to increase channels for aqueous fluid to be drained from the eyes to manage intraocular pressure. The procedure is usually done when treatment with medication or laser does not work and intraocular pressure cannot be adequately lowered.

Benefits
To manage intraocular pressure and/or prevent blockages in the tear drainage system, which can delay the deterioration of the optic disc and maintain remaining visual field as long as possible.
  1. Understand the procedure, including risks and benefits.
  2. Prepare physically for the procedure, such as by avoiding infection. If general anesthesia will be used for the procedure, the doctor will ask you to meet an internal medicine doctor and an anesthesiologist to assess your readiness for the procedure.
  3. Carefully follow all pre-operative instructions, including fasting (if general anesthesia is used), and stopping blood-thinning medication.
  4. Sign consent forms for the procedure or surgery.
  5. Do not wear makeup on the day of the procedure. Wash your face and hair on the day of the procedure.
  6. Do not wear any accessories or valuables to the hospital.
  7. Tell your doctor if you use regular eye drops for existing medical conditions, such as those for glaucoma.
You will be given eye drops to dilate your pupils and antibiotics as recommended by the doctor. During the procedure you will be conscious. Do not move your head. A drape will cover your face. The procedure takes about 20-30 minutes.
 
  1. Lie flat on your back without a pillow. If you are uncomfortable or fatigued, you may roll to your side, but not on the affected side.
  2. Use the eye cover when you sleep.
  3. Avoid coughing or sneezing too hard.
  4. Do not rub your eye or let water get in your eye for at least two weeks.
  5. You can take the pain medication prescribed by your doctor.
  1. Increased intraocular pressure.
  2. Severe eye pain, which can be managed by prescribed pain medication.
  3. Infection. If you experience any abnormal symptoms, such as severe eye redness, excessive eye discharge, and/or constant eye pain, please see the doctor immediately.
  4. Bleeding in the space in front of the pupil.
There are no travel limitations before and after the procedure.
 
The success of the procedure depends on the pathology and severity of the condition. Your ophthalmologist will carefully assess all test results.

What if the procedure is not performed?
In patients with glaucoma and high intraocular pressure, if treatment with medication or laser does not decrease the pressure, without surgery the intraocular pressure will continue to increase and place pressure on the optic disc, which will then lead to permanent loss of vision.

 
If this treatment is not successful, the doctor would recommend surgery to place a glaucoma drainage device (GDD) to drain fluid from the space in front of the pupil.

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