Laser trabecular sclerosis for chronic hypotony after vitreoretinal surgery

Abstract

Purpose To perform a pilot study of laser trabecular sclerosis (LTS) for chronic ocular hypotony after vitreoretinal surgery. Design Prospective noncomparative case series. Participants Three patients with chronic hypotony after vitreoretinal procedures underwent LTS. All patients had undergone complex vitreoretinal surgery with attached retinas postoperatively but with persistent hypotony and poor vision. Intervention Laser trabecular sclerosis was performed in a fashion similar to laser trabeculoplasty, using a 100-μm spot, 800 to 1000 mW power at 0.1 seconds, and applying heavy confluent treatment in ≥1 sessions throughout the angle where trabecular meshwork was visible. Main outcome measures Intraocular pressure (IOP), best spectacle-corrected visual acuity, and complications were studied. Results In 1 patient, a single session of LTS was followed by an increase in IOP of approximately 4 mm, with subjective and objective improvement in vision. A second patient exhibited improvement in IOP and visual acuity after 3 sessions of LTS. A third patient underwent 3 sessions of LTS without improvement in IOP or vision. Conclusion Given the limitations of this small series, including the lack of a randomized prospective design, it is not possible to determine the safety or efficacy of LTS, but this study does suggest that this procedure could play a therapeutic role in some patients with chronic symptomatic hypotony after complex intraocular surgery. Further study is warranted.