Nd:YAG laser trabeculopuncture in angle-recession glaucoma

Nd:YAG laser trabeculopuncture (YLT) was performed in 12 eyes of 12 patients with angle-recession glaucoma. Confluent, 1-clock-hour trabeculotomy was attempted in all eyes. The calculated average laser energy was 181 +/- 86 mJ. Where possible, the midtrabecular meshwork was treated, preferably at the superior half. After a mean follow up of 12.0 +/- 5.6 months, intraocular pressure (IOP) was controlled (less than or equal to 19 mm Hg) in five eyes (41.7%). YLT was associated with blood reflux during or after treatment in all successfully treated eyes. In eyes that failed, blood reflux could be detected in only two of seven eyes (28.6%). YLT failed to control IOP in all five eyes that had angle-recession for 360 degrees. Following YLT, IOP rose in two eyes (16.6%), minimal hyphema occurred in one eye, and temporary flare and cells developed in the anterior chamber in all eyes. Six eyes (50%) required glaucoma surgery (four had trabeculectomy and two had Molteno implant surgery). We recommend YLT only for selected cases of uncontrolled angle-recession glaucoma in which at least part of the trabecular meshwork by gonioscopy appears to maintain its anatomical structure, permitting penetration into Schlemm's canal.