Comparison of early versus late laser goniopuncture following deep sclerectomy for the management of open-angle glaucoma

Br J Ophthalmol. 2020 Oct;104(10):1384-1389. doi: 10.1136/bjophthalmol-2019-315392. Epub 2020 Feb 5.

Abstract

Purpose: To compare the outcome of early versus late Nd:YAG laser goniopuncture (LGP) after deep sclerectomy with mitomycin C (DSMMC) for open-angle glaucoma (OAG).

Methods: A retrospective study of consecutive OAG eyes that underwent a LGP following DSMMC was recruited between June 2012 and November 2015. Success was defined as intraocular pressure (IOP) less than 21, 18 or 15 mm Hg with a reduction of more than 20% IOP from baseline without (complete success) or with medications (qualified success).

Results: 99 eyes with OAG that underwent DSMMC were recruited into the study. Of these, 49 eyes (49.49%) had undergone LGP post-DSMMC. IOP was significantly reduced following LGP from 28.4 to 11.8 mm Hg. Comparison of Kaplan-Meier survival curves out to 60 months after LGP showed a trend towards better outcomes in the late LGP group with the only statistically significant difference noted for qualified success with IOP target <15 mm Hg. Complications were few with no difference noted between early and late LGP groups.

Conclusion: There appears to be a trend towards late LGP being more effective after DSMMC when compared with early LGP; this however was not significant. This study corroborates previous published data confirming LGP is an effective and safe procedure for lowering IOP post-DSMMC procedure.

Keywords: angle; glaucoma; intraocular pressure; treatment lasers; treatment surgery.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Alkylating Agents / administration & dosage
  • Female
  • Glaucoma, Open-Angle / physiopathology
  • Glaucoma, Open-Angle / surgery*
  • Humans
  • Intraocular Pressure / physiology
  • Laser Therapy / methods*
  • Lasers, Solid-State / therapeutic use*
  • Male
  • Middle Aged
  • Mitomycin / administration & dosage
  • Punctures*
  • Retrospective Studies
  • Sclerostomy / methods*
  • Tonometry, Ocular
  • Trabecular Meshwork / surgery*
  • Treatment Outcome

Substances

  • Alkylating Agents
  • Mitomycin