[External sclerostomy using the THC:YAG Holmium laser in the treatment of glaucoma]

Ab externo THC:YAG Holmium laser sclerostomy is an interesting alternative to standard full thickness filtering surgery. We report our retrospective experience over a total number of 38 sclerostomies between march 1993 and september 1994 on 32 patients (33 eyes) with primary or secondary glaucomas composed of 17 phakic and 16 aphakic and/or pseudophakic eyes. The mean patient age is 62.9 years (range: 10 to 90 years). The mean follow-up time is 7.5 months (1 to 18 months). We used a long pulsed (300 microsec) laser emitting in the near infrared (2.1 microns). A conjunctival stab incision was made 12 mm away from the sclerostomy site to allow entry of a 22 G probe which delivers energy at a right angle to the long axis of the fiber. We used 100 mJ per pulse laser energy delivered at a rate of 5 impacts per second. The mean delivered energy to produce a functional sclerostomy was 16.1 J. All patients received subconjunctival injections of 5 Fluorouracil (mean number of injections: 7.4). Criteria for success included an IOP of 22 mmH or less with or without additional medical treatment and a decrease of at least 30% of IOP when the preoperative IOP was 22 mmHg or less. The mean preoperative IOP was 35.8 mmHg (21 to 54 mmHg). By 3 months, the mean IOP of the 14 eyes over 19 successfully controlled was 15.2 mmHg (8 to 22 mmHg) with additional medical treatment in 3 cases. By 6 months, 11 eyes over 11 successfully controlled was 14.1 mmHg (6 to 21 mmHg) with additional medical treatment in 3 cases.(ABSTRACT TRUNCATED AT 250 WORDS)