Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma

During the past 18 months, 23 cases of advanced neovascular glaucoma, unresponsive to medical therapy, have been treated by a trabeculostomy procedure using a carbon dioxide laser. This procedure entails surgical entry into the anterior chamber from beneath either a conjunctival or a scleral flap in such a way as to completely cauterize any neovascular tissue in the iridocorneal angle and to permit adequate drainage of the aqueous fluid from the anterior chamber to the periocular space. The average intraocular pressure, prior to carbon dioxide laser trabeculostomy was 54 mm Hg and these pressures were lowered below 18 mm Hg in over 57% of the cases followed for longer than six months post-laser therapy. Treatment was considered a failure in 26% of the cases where the intraocular pressure was not lowered substantially, and 17% of the treated eyes sustained a pressure decrease to within the 25 to 35 mm Hg range. Carbon dioxide laser trabeculostomy or trabeculo-sclerostomy provides a new method of lowering the intraocular pressure in severe cases of neovascular glaucoma without the hazard of intraocular hemorrhage, common with other filtration procedures. These procedures have proved satisfactory in alleviating the high pressures of neovascular glaucoma in a relatively large proportion of the patients treated. If the eye is grossly hyperemic and irritated because of the high intraocular pressure and the deteriorated condition of the eye, it is suggested that the carbon dioxide laser trabeculostomy procedure with a scleral flap be performed with an implanted seton as the procedure of choice. If the eye is relatively quiet and has some visual reserve but an exceedingly high and intractable intraocular pressure, it is advisable to use either the carbon dioxide laser trabeculostomy procedure or the carbon dioxide laser trabeculo-sclerostomy operation as described. These procedures are being further refined, but the results of this investigation suggest that these procedures can be utilized judiciously, and should prove useful, particularly in those eyes with advanced neovascular glaucoma with useful vision still remaining.