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Nd:YAG laser goniopuncture after deep sclerectomy: outcomes
1Department of Ophthalmology, Calderdale and Huddersfield NHS Trust, Huddersfield Royal Infirmary, Huddersfield, West Yorkshire, UK. anand1604@gmail.com
Acta Ophthalmologica
|March 24, 2009
Summary
Nd:YAG laser goniopuncture effectively lowers intraocular pressure after deep sclerectomy, with about 50% of patients maintaining target IOP for two years. Regular gonioscopy is advised to monitor for iris occlusion complications.
Area of Science:
- Ophthalmology
- Glaucoma Surgery
- Laser Therapy
Background:
- Deep sclerectomy (DS) is a surgical procedure to reduce intraocular pressure (IOP).
- Further IOP reduction may be necessary in some patients post-DS.
- Nd:YAG laser goniopuncture (LGP) is a potential adjunctive therapy.
Purpose of the Study:
- To evaluate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) for lowering IOP after deep sclerectomy (DS).
Main Methods:
- Retrospective review of 258 eyes undergoing DS or combined phacoemulsification and DS.
- Mitomycin C used in 74.4% of surgeries.
- Analysis of outcomes following LGP in 173 eyes.
Main Results:
- Mean follow-up: 40 months post-DS, 31 months post-LGP.
- At 2 years post-LGP, 49.7% of eyes maintained IOP < 15 mmHg with a 20% decrease and no further intervention.
- Iris covering the trabeculo-Descemet's membrane was a significant factor for LGP failure (HR 3.0, p < 0.001).
- Complications included peripheral anterior synechiae (13.2%) and hypotony (4.0%).
Conclusions:
- Nd:YAG laser goniopuncture is an effective secondary procedure to lower IOP after DS.
- Approximately 50% of patients achieve sustained IOP reduction for over two years with a single LGP.
- Regular gonioscopy is recommended to detect iris occlusion of the goniopuncture site.
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