A comparison of the efficacy of Holmium laser sclerostomy ab externo versus trabeculectomy in the treatment of glaucoma

Abstract

We compared 15 patients who had undergone Holmium laser sclerostomy ab externo with 15 who had had trabeculectomy. In the short term, laser sclerostomy led to adequate control of intraocular pressure, but in the longer term it compared unfavourably with trabeculectomy in terms of efficacy, complications and reoperation rate. At 1 year follow-up, 8 patients in the laser group had had to undergo a second operation compared with none in the control trabeculectomy group, and 7 were still on glaucoma medication compared with 2 in the control group. Iris prolapse into the internal sclerostomy ostium within 2 months accounted for most failures, and was only partially amenable to Nd:YAG peripheral iridectomy. This common complication seems to be related to anterior chamber depth. There also appears to be a tendency for blockage of the sclerostomy with cellular or fibrinous debris. Recent literature is reviewed and modifying strategies discussed.

Holmium YAG laser sclerostomy ab externo for refractory glaucoma

“…In addition, in previous reports, there seems to be no clinical difference in the success rate of sclerostomies performed on eyes treated with 5-FU [3,8] and those without 5-FU [6,7]. Since the patient selection process and success criteria are different in these previous studies, the results cannot be compared.…”

“…In this respect, subconjunctival thermal sclerostomy with the holmium YAG (chromium-sensitized thulium and holmium-doped) laser can create a full-thickness filtering fistula without the need for a large conjunctival incision or intraocular manipulation. Although recent clinical reports have confirmed the safety and efficacy on this method for use in glaucoma filtration surgery [1][2][3][4][5][6][7][8], several problems remain. The procedure has a relatively lower success rate than that obtained using conventional trabeculectomy and has specific complications, such as iris incarceration at the sclerostomy site.…”

“…The laser settings and IOP control rates Iwach et al[3] Schuman et al[4] MeAllister et al[5] Bonoi et al[6] Ah-Fat et al[7] Hara et al[8] …”