Prospective study of ab externo erbium:YAG laser sclerostomy in humans.

Abstract

PURPOSE:

To evaluate the efficacy of ab externo erbium:YAG (Er:YAG) laser sclerostomy in controlling intraocular pressure in eyes with uncontrolled glaucoma.

METHODS:

We performed ab externo laser sclerostomy on eyes of 26 patients. Mean +/- SD postoperative follow-up was 11.4 +/- 0.9 months. Complete success was defined as intraocular pressure below 22 mm Hg with no adjunct medication; qualified success was defined as intraocular pressure below 22 mm Hg with medication.

RESULTS:

In all eyes, ab externo Er:YAG laser sclerostomy achieved a functioning fistula with a prominent filtering bleb. Twelve eyes had had neodymium:YAG (Nd:YAG) laser iridotomy at the site of laser sclerostomy 2 weeks before filtering surgery; 14 eyes had surgical iridectomy at the site of laser sclerostomy. Mean preoperative intraocular pressure of 30.7 +/- 7.3 mm Hg (range, 17.0 to 48.0 mm Hg) was significantly (P < .05) reduced to 18.3 +/- 1.0 mm Hg (range, 0 to 25.0 mm Hg) at 2 weeks postoperatively. thereafter, marked regression was noted: at 1 month postoperatively, intraocular pressure was 20.1 +/- 9.5 mm Hg (range, 4.0 to 44.0 mm Hg); half-life of complete success was 25 days; of qualified success, 56 days; and of a functioning filtering bleb, 36 days.

CONCLUSIONS:

Ab externo Er:YAG laser sclerostomy reliably created successful full-thickness fistulae with prominent filtering blebs in human glaucomatous eyes. However, a transient phase of ocular hypotony caused by aqueous overfiltration, followed by an ongoing rate of fistula patency failure, renders Er:YAG laser sclerostomy, as performed in this study, unsuitable for long-term pressure control.

• Authors: P C Jacobi, T S Dietlein, G K Krieglstein
• Journal: American journal of ophthalmology (Am J Ophthalmol) Vol. 123 Issue 4 Pg. 478-86 (Apr 1997) ISSN: 0002-9394 [Print] United States
• PMID: 9124244 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Glaucoma, Angle-Closure (pathology, surgery)
• Glaucoma, Open-Angle (pathology, surgery)
• Humans
• Intraocular Pressure
• Laser Therapy
• Male
• Middle Aged
• Postoperative Complications
• Prospective Studies
• Sclera (pathology, surgery)
• Sclerostomy (methods)
• Treatment Outcome