COMMENTARY

Laser Goniopuncture for Bleb Revision

Shuchi B. Patel, MD

Disclosures

April 30, 2014

Nd:YAG Laser Goniopuncture for Late Bleb Failure After Trabeculectomy With Adjunctive Mitomycin C

Susanna R Jr, De Moraes CG, Alencar LM, Ritch R
JAMA Ophthalmol. 2014;132:286-290

Study Summary

A prospective, noncomparative, interventional cohort study including 19 eyes of 19 patients with uncontrolled glaucoma after failed trabeculectomy was performed. The intervention studied was Nd:YAG laser goniopuncture (LGP), followed by a 5-fluorouracil (5-FU) injection. LGP was performed by focusing the laser beam as deep as possible into the ostium. Ten to 20 single shots were applied with energy levels between 7 and 8 mJ. Immediately following, 5 mg of 5-FU (50 mg/mL) was injected in the inferior conjunctival fornix.

The mean (standard deviation) intraocular pressure (IOP) before LGP was 20.9 (4.75) mm Hg and fell significantly to 5.8 (2.9) mm Hg immediately after LGP (P < .001). On the day after LGP, the mean IOP was 9.3 (4.3) mm Hg. At 6 months after LGP, the mean IOP had declined to 11.9 (4.1) mm Hg (P < .001). The mean reduction was −9.0 (6.3) mm Hg or −40.5% (24.0%). At the last follow-up visit, 15 eyes (79%) had achieved an IOP of 15 mm Hg or less, with a minimum IOP reduction of 20% from baseline without medication use. The only complications observed after LGP were 2 cases of hypotony, which resolved spontaneously.

Therefore, Nd:YAG LGP may be an effective procedure to lower IOP in eyes with ischemic nonfunctioning blebs and patent trabeculectomy ostia.

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