Transconjunctival Nd:YAG laser revision of failing trabeculectomy

We used a Q-switched Nd:YAG laser delivered transconjunctivally to restore filtration to a failing trabeculectomy of a 51-year-old black woman with primary open-angle glaucoma and uncontrolled intraocular pressure (IOP) on maximally tolerated anti-glaucoma medical therapy. Initially, the Nd:YAG laser was directed via a goniolens at the interface of the trabeculectomy flap and scleral bed. This attempt to restore filtration was unsuccessful. In two separate treatment sessions the Nd:YAG laser was directed transconjunctivally onto the visible trabeculectomy flap margins, followed by focusing the laser onto the gray-white episcleral fibrous tissue overlying the scleral flap. During the last transconjunctival treatment, the bleb elevated immediately and the IOP decreased from 30 mm Hg to 18 mm Hg. These effects have been sustained over 3 months of follow-up.