Effectiveness of Laser Goniopuncture as an Adjuvant Therapy to Non-Penetrating Deep Sclerectomy for Lowering Intraocular Pressure

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Purpose : The purpose of this study is to examine the efficacy of laser goniopuncture (LG) in lowering intraocular pressure(IOP) after non-penetrating deep sclerectomy (NPDS). A minority of eyes undergoing successful NPDS demonstrate gradual increase in IOP 6-24 months after the procedure despite maintenance of good bleb elevation and an open superior angle. This is often the result of accretion of protein or pigment in the intact internal trabeculum diminishing the flow of aqueous into the intrascleral lake and bleb. Nd/YAG laser can be used to disrupt this material and modify the trabeculum restoring aqueous flow.

Methods : Retrospective chart review. Inclusion criteria were all adults who had undergone NPDS with 0.4mg/ml Mitomycin C who thereafter unilateral LG after developing gradual IOP increase prior between January 2012 and August 2018, with pre-operative IOP measurements taken on the same day of the subsequent laser procedure. GP was performed using a Goldmann 4-mirror lens. Laser settings were typically set high, between 6 and 9 mJ, using the Ellex YAG, with a total energy application range between 500 and 800 mJ. IOP measurements of the same eye at subsequent visits were recorded along with date of appointment. IOP comparisons from baseline were performed using paired t-tests.

Results : Mean IOP before LG was 25.4±9.4 (range: 11-62, N=78). Mean IOP for monthly intervals as follows: 11.2±6.8 (range: 3-39, N=43) at one month, 11.9±5.5 (range: 3-39, N=58) within six months, and 14±3.7 (range 9-23, N=31) at twelve to eighteen months after LG. Mean IOP differences compared to baseline were 15.3±11.1 (p<0.001, 95% CI=11.9-18.7), 14±11.5 (p<0.001, 95% CI=10.9-17.0), and 9.5±8.6 (p<0.001, 95% CI=6.3-12.6), respectively.

Conclusions : Laser goniopuncture was an effective adjuvant treatment modality for enhancing the efficacy of non-penetrating deep sclerectomy (NPDS) in lowering IOP, and was able to achieve a mean target IOP of 15 for up to eighteen months post-LG.


This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.