Deep sclerectomy with Nd:YAG laser trabeculotomy ab interno: two-stage procedure

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Research

Background:

• Open-angle glaucoma management often requires advanced surgical interventions when medical therapy fails.
• Previous laser trabeculoplasty (LTP) and trabeculectomy have limitations in efficacy and safety.
• Uncontrolled intraocular pressure (IOP) despite maximal medical therapy and prior LTP necessitates alternative surgical strategies.

Purpose of the Study:

• To evaluate a novel two-stage Nd:YAG laser trabeculotomy technique for medically uncontrolled open-angle glaucoma.
• To assess the efficacy and safety of this new surgical approach in reducing intraocular pressure.
• To compare outcomes with existing glaucoma treatment modalities.

Main Methods:

• A two-stage surgical procedure was developed, involving scleral block removal and subsequent Nd:YAG laser trabeculotomy.
• The technique was applied to 17 eyes (11 patients) with severe, medically uncontrolled phakic and pseudophakic open-angle glaucoma.
• Intraocular pressure (IOP) was measured preoperatively and postoperatively, with a minimum follow-up of 12 months.

Main Results:

• Mean preoperative IOP was 38.3 mmHg, significantly reduced to a mean final postoperative IOP of 16.9 mmHg.
• 70% of eyes (12 out of 17) achieved a final postoperative IOP below 21 mmHg.
• The only complication observed was minimal, transient bleeding from the trabeculum/Schlemm's canal, resolving within 24 hours.

Conclusions:

• The described two-stage Nd:YAG laser trabeculotomy is a safe and effective procedure for lowering IOP in refractory open-angle glaucoma.
• This technique offers a promising alternative for patients who have failed medical management and previous LTP.
• Further studies are warranted to establish long-term efficacy and compare it directly with other surgical glaucoma treatments.