Outcomes of Laser Goniopuncture Following Nonpenetrating Deep Sclerectomy With Mitomycin C: A Large Retrospective Cohort Study

Abstract

Purpose: To report on the frequency, efficacy, and safety of laser goniopuncture (LGP) in lowering intraocular pressure (IOP) following mitomycin-C-augmented nonpenetrating deep sclerectomy (NPDS) in a large cohort of eyes. Materials and Methods: This is a monocenter database retrospective study. We reviewed records of 350 eyes that underwent NPDS between 2009 and 2015, at the National Ophthalmology Center of XV-XX (Paris, France). We recorded the incidence of LGP, the time between NPDS and LGP, IOP efficacy, and the occurrence of complications. The success of the LGP was defined by an IOP<15 mm Hg without hypotonic treatment. Results: The mean postoperative follow-up period was 19±15.9 months after the NPDS (range, 6 to 58). LGP was performed in 125 eyes (35.7%) in a mean time after NPDS of 7.4±7.6 months (range, 1 d to 36 mo). Most LGP procedures were performed during the first year (97 eyes, 77.6%). The survival analysis using the Kaplan-Meier method showed a 50% incidence of LGP by 2 years. The mean IOP before LGP was 23.8±7.1 mm Hg. LGP resulted in immediate (day 8) and significant IOP lowering by up to 15±6.8 mm Hg. This decrease was maintained throughout the follow-up period, and the Kaplan-Meier survival success rate at 2 years was 48.9% (95% confidence interval, 39.4-60.8). The most common complication was iris incarceration, which occurred in 22 eyes of 125 LGP (17.6%). Conclusions: Most of the eyes that underwent NPDS may require LGP to reduce the IOP to below the target value. Most often, this procedure was performed in the first year after NPDS (77.6%). LGP lowered IOP<15 mm Hg without any hypotonic medication for at least 2 years in 50% of cases. Goniopuncture is associated with potentially significant complications, of which the most common is iris incarceration. We identified 2 predicting factors for iris incarceration: high IOP before LGP and early LGP after NPDS.

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

“…The most common one was iris incarceration, which occurred in 17.6% eyes underwent Nd:YAG laser goniopuncture (24). High IOP before the treatment and laser intervention within 3 months after NPDS were two predicting factors of iris incarceration (24). In this study, we did not observe any remarkable iris incarceration after Nd:YAG laser goniopuncture.…”

“…Despite the beneficial effect, Nd:YAG laser goniopuncture was associated with some potential complications. The most common one was iris incarceration, which occurred in 17.6% eyes underwent Nd:YAG laser goniopuncture (24). High IOP before the treatment and laser intervention within 3 months after NPDS were two predicting factors of iris incarceration (24).…”

“…For these reasons, either the "window" or the "lake" could scar down over time, which could be easily identified by UBM. Nd:YAG laser goniopuncture was an adjunctive procedure to achieve further reduction of IOP, by turning a nonpenetrative surgery into a micropenetrating surgery (24). It was reported that Nd:YAG laser goniopuncture could reduce the IOP by 42% after NPDS (25) and over 50% patients achieved IOP < 15 mm Hg without any hypotonic medication for at least 2 years (24).…”

“…Nd:YAG laser goniopuncture was an adjunctive procedure to achieve further reduction of IOP, by turning a nonpenetrative surgery into a micropenetrating surgery (24). It was reported that Nd:YAG laser goniopuncture could reduce the IOP by 42% after NPDS (25) and over 50% patients achieved IOP < 15 mm Hg without any hypotonic medication for at least 2 years (24). About 41 to 63% proportion of Nd:YAG laser goniopuncture treatment was reported in published studies (26,27).…”

CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

“…For this patient, a diffuse subconjunctival bleb and a deep scleral lack were maintained in OS postoperatively, which contributed to a lower and stable IOP. LGP was an adjunctive procedure after CLASS, which could achieve a further IOP reduction by turning a non-penetrative surgery into a micorpenetrating surgery ( 39 ). However, the incidence of shallow AC was relatively low in CLASS than in Trab for POAG patients, with an incidence of 1.5% vs. 6.2% in Caucasian ( 40 ) and 0% vs. 21.3% in Chinese patients ( 35 ).…”