[Adverse effects and complications of argon laser trabecular retraction: practical results]

Argon laser trabeculoplasty is learned and used much more easily than filtration surgery. This explains the danger of its being abusively employed, as well as the existence of complications such as an aggravated glaucoma condition (1 to 3% of the cases). In 253 eyes afflicted with various forms of chronic open angle glaucoma with follow-ups ranging from at least 6 months to 4 years, the following complications were disclosed: 3% of the cases required treatment for severe anterior uveitis; anterior synechiae occurred in 23%, including one case of circular anterior synechiae and 4 other cases in which acute angle closure glaucoma developed several months later; trabecular hemorrhage in 6%; post operative intra ocular pressure elevation in 13%. This last complication is the most dangerous especially in advanced glaucoma: it very frequently happens during the first post operative hours in the absence of preventive treatment and it can arise up to three weeks after the procedure. In 33 cases upon 253 (13%), the pressure increase, despite a systematic preventive treatment, ranged from +3 mmHg to +16 mmHg above the baseline level in more than two thirds of these particular cases (+5 mmHg in only 7.5% of the cases and +9 in only 3.5%). In 59 eyes treated by less intensive trabeculoplasty (50 burns upon 180 degrees trabeculoplasty ring), the pressure increased in only 3.4% of the cases but the long term efficacy was reduced. Argon laser trabeculoplasty complications are less numerous than those of surgery, but some of them, i.e. intra ocular pressure elevation, can be very serious and must lead to a study of the risk-benefit ratio corresponding to the glaucoma stage which is to be treated.