Optimization of Angle Surgery with ACT: Anesthesia, Control, Timing

After routine cataract extraction (CE) under direct gonioscopy, a Sinskey hook was advanced toward the angle to mimic angle surgery (AS). An ocular excursion resulted in a 4 clock-hour iridodialysis. This case study considers a number of variables to optimize patient safety to avert adverse outcomes and build surgical confidence. Essential components include use of lidocaine gel for pain control as a coupling agent with the goniolens for better patient cooperation and lower tissue manipulation sensation, globe control with fixation from the peripheral flange or cleat ring of goniolenses, and timing with pre-CE AS providing intact ocular integrity and a clear view of the angle through an unaltered cornea and keratome incision.