[Excimer laser sclerostomy of secondary glaucoma]

Initial results after nine ab externo sclerotomies on seven patients awaiting enucleation because of intensive pain caused by secondary glaucoma have encouraged us to present the methods used for this technique of fistula construction and the course in these patients. A special applicator permits precise manual positioning of the excimer laser beam (lambda = 308 nm) subconjunctivally at the limbus using a quartz-quartz fiber (diameter: 0.32 mm). The energy applied at the fibertip is 4 mJ per pulse, with a repetition rate of 80 Hz. All patients undergoing the operation, which lasted only a few minutes, were treated as out-patients without a retrobulbar anaesthesia. Because of the minimal irritation of the anterior chamber, only antibiotic treatment was required after the operation. The intraocular pressure immediately decreased to normal levels after the operation without any further glaucoma treatment in five cases. In the other two cases reduced, but still minimally elevated, pressure was recorded. In the case of one heavily inflamed eye, which had been subjected to two operations, pain felt by the patient was relieved when the pressure was reduced. The maximum period of post-operative follow-up so far is over 10 months and the decrease of intraocular pressure has remained adequate without any additional antiglaucoma therapy. In all cases enucleation was avoided.