Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma

During the past 24 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 scleral flap in such a way as to completely cauterize any neovascular tissue in the corneoscleral angle and to permit adequate drainage of the aqueous in fluid from the anterior chamber to the periocular space. The average intraocular pressure prior to carbon dioxide laser trabeculostomy was 54 mmHg and these pressures were lowered below 18 mmHg in over 70% of the cases followed for longer than six months postlaser therapy. Treatment was considered a failure in 16% of the cases where the intraocular pressure was not lowered substantially. Fourteen percent of the treated eyes sustained a pressure decrease to within the 26-35 mmHg range. Carbon dioxide laser trabeculostomy 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 or the ciliary destruction present with the cyclocautery operations. The indications, surgical technique, and complications will be discussed.