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ABSTRACT
Anterior synechiae that develop following keratoplasty may induce immunological graft rejection or graft failure. Current surgical techniques designed to remove the synechiae early on are quite cumbersome. We describe a simple technique of anterior synechiolysis, performed 1 to 4 weeks postoperatively, using a bent 26-gauge needle, that proved safe and effective in seven cases. The only complication was a hyphema in one case. None of the synechiae had recurred at the final follow up at 3 months.
Shallowing of the anterior chamber and anterior iris adhesion is a known complication following penetrating keratoplasty.1'2 Left untreated, such adhesions may compromise graft clarity.2"4 Current techniques of anterior synechiolysis are cumbersome and may themselves be associated with intraoperative and postoperative complications. We report a simple and effective technique of anterior synechiolysis using a 26-gauge needle.
PATIENTS AND METHODS
Seven patients in whom anterior synechiae of more than 1 clock-hour extent were found at the host-graft interface following penetrating keratoplasty were enlisted to undergo synechiolysis. Preoperative evaluation included measurement of Snellen visual acuity where possible; slit-lamp biomicroscopy to assess graft status, the exact position and extent of any anterior synechiae, and anterior chamber inflammation; Seidel's test to detect wound leak; and either Goldmann or Perkins applanation tonometry. The patients in cases 2 and 4 required sedation under trichlorophosphate sodium for clinical evaluation. Cases with clinically detectable wound leak were excluded from the study, since they required resuturing or suture reinforcement at the leakage site, and the anterior chamber was uniformly shallow, with associated gross hypotony, complicating needle synechiolysis.
SURGICAL TECHNIQUE
In all cases (except case 3, in which topical 4% lignocaine anesthesia was used), synechiolysis was performed under inhalation anesthesia by face mask using 2% halothane for induction and 1% for maintenance. A disposable 26-gauge needle, 1.25 cm long, was bent 90° near its base and attached to a 2-cubiccentimeter glass syringe containing 2% methylcellulose. After the eyeball had been fixed with a Lim's forceps, the needle was introduced into the anterior chamber in an area adjacent to the synechiae, creating a self-sealing tunnel starting from the limbus (external opening) and proceeding to a point just posterior to the host-graft junction (internal opening).
A small quantity of viscoelastic was injected...