[Thulium-holmium-chromium-doped YAG laser sclerostomy ab externo in uncontrollable glaucoma]

Laser sclerostomy ab externo, using thulium-holmium-chromium-doped YAG laser was performed in 40 eyes with refractory glaucoma. Preoperative intraocular pressure (IOP) ranged from 21 to 50 mmHg (mean +/- SD: 33 +/- 18.6) with maximum tolerable medications. In all cases, a full-thickness sclerostomy was performed and subsequently a filtering bleb was formed. Total energy levels to produce the sclerostomy ranged from 0.2 J to 12.9 J (3.9 +/- 2.4). Follow-up periods varied from 3 to 18 (9 +/- 4) months. IOP control rate calculated by a life-table method at 6 and 12 months after surgery was 54% and 46%, respectively. IOP for successful eyes ranged from 0 to 18 mmHg (12.3 +/- 2.4). As complications, corneal fold formation (all eyes), choroidal detachment (12 eyes), hyphema (10 eyes), and iris incarceration in the sclerostomy site (4 eyes) were found. Astigmatism caused by corneal fold formation disappeared spontaneously within 3 months. Iris incarceration causing IOP elevation was repaired by Nd-YAG laser treatment and IOP control was obtained in 2 of 4 eyes. No other complications were observed.