Eight-year follow-up of excimer laser trabeculostomy alone and combined with phacoemulsification in patients with open-angle glaucoma.

PURPOSE: To describe the 8-year results of excimer laser trabeculostomy (ELT) alone and ELT in conjunction with phacoemulsification (phaco). SETTING: University hospital. DESIGN: Retrospective review. METHODS: 308 nm excimer laser energy delivered through an intraocular fiber-optic probe created channels through the inner wall of Schlemm canal. 2 groups were studied: ELT alone and ELT + phaco. Inclusion criteria were adult patients with open-angle glaucoma or ocular hypertension on 1 or more intraocular pressure (IOP)-lowering medications and, in the ELT + phaco group, presence of visually significant cataract. Primary outcome measures were change of IOP from baseline and number of IOP-lowering medications. RESULTS: 164 eyes in 2 groups, ELT alone (n = 90) and ELT + phaco (n = 74), were followed up for 8 years. Baseline IOP was 22.17 ± 7.0 mm Hg and 21.9 ± 6.44 mm Hg in the ELT alone and the ELT + phaco groups, respectively. IOP in the ELT alone group decreased to 16.84 ± 5.2 mm Hg at 1 year (n = 69) and remained at 15.9 ± 3.5 (n = 19) at 8 years. IOP in the ELT + phaco group was 14.04 ± 4.1 mm Hg at 1 year (n = 63) and 13.7 ± 2.8 mm Hg at 8 years (n = 13). The number of IOP-lowering medications at baseline in the ELT alone group was 1.85 ± 0.8 and decreased to 1.19 ± 1.10 at 1 year and 1.4 ± 1.4 at 8 years. In the ELT + phaco group, it was 1.58 ± 0.8 at baseline and decreased to 0.97 ± 0.95 at 1 year and 1.85 ± 0.7 at 8 years. CONCLUSIONS: ELT demonstrated long-term IOP lowering and decrease in the number of IOP-lowering medications. Benefits of this laser-based implant-free microinvasive glaucoma surgery procedure included a high safety profile and long-term efficacy.

Mitomycin-augmented non-penetrating deep sclerectomy: preoperative gonioscopy and postoperative perimetric, tonometric and medication trends.

BACKGROUND/AIMS: Non-penetrating deep sclerectomy (NPDS) can enhance drainage of aqueous humour without disrupting the trabecular endothelial layer, reducing risks of postoperative hypotony and hyphema. This study explores associations of angle morphology with surgical efficacy in eyes with open and obstructed angles. METHODS: Eighty-nine consecutive eyes undergoing successful NPDS (non-implant, with 0.4 mg/ml mitomycin C and limbus-based two-layer closure) were studied in this institutional review board-approved retrospective quality assurance study. Postoperative complication frequency, intraocular pressure (IOP), glaucoma medications required and acuity were monitored (baseline vs 3, 6, 9, 12 and 18-month postoperative levels), along with 30-2 Humphrey MD and corrected pattern standard deviation (CPSD) (baseline vs 6, 12 and 18-month postoperative values). Preoperative gonioscopy was compared with the subsequent requirement for specific postoperative interventions. RESULTS: IOP at all five postoperative intervals was reduced (22 ± 0.9 to 12 ± 0.5 mm Hg; p<0.0001). No hyphema were observed. Postoperative hypotony (IOP < 4 mm Hg) occurred rarely (8/445; 1.8%). Mean glaucoma medication use dropped from 3.1 ± 0.1 to 0.23 ± 0.1 at 18 months (p<0.0001). Mean 30-2 MD improved by approximately 1.4 dB at 6, 12 and 18 months (p<0.002); CPSD remained stable. CONCLUSIONS: Following NPDS, a sustained IOP decrease of 10 mm Hg (45%) was attained, with stable acuity, increased perimetric generalised light sensitivity and 90% reduction in medical therapy requirement. Morbidity risk was associated with narrow gonioscopic angle insertion and synechia, but not with shallow approach or trabecular pigmentation.