Holmium laser sclerostomy: a clinical study

A prospective study of 30 glaucoma patients (one eye in each patient) treated by an ab externo holmium laser sclerostomy is presented. An average of 40.2 pulses with an energy of 100 mJ was necessary to produce a filtering bleb. The average pre-operative intraocular pressure was 25.5 +/- 7.4 mmHg, with an average of 14.06 +/- 5.7 mmHg post-operatively at the final follow-up. The mean follow-up was 7.5 months (range 5-12 months) and the mean age of the patients was 71.4 years. Using strict criteria 70% of sclerostomies were considered successful at the final follow-up visit. The main post-operative complication was iris plugging of the sclerostomy. This was dealt with successfully with a 'Q'-switched neodymium:YAG laser in 80% of cases. Our early experience with the laser suggests that it is an easy, quick method of producing a filtering bleb, and may be carried out as an office procedure. As the technique evolves its long-term success remains to be evaluated; however, it shows promise both as an alternative to trabeculectomy as a primary procedure and as an additional technique for more complicated cases of glaucoma.