Nd:YAG laser goniopuncture in viscocanalostomy: penetration in non-penetrating glaucoma surgery

Abstract

The objective was to evaluate the results of Nd:YAG laser goniopuncture after viscocanalostomy and to investigate the rate of penetration in non-penetrating surgery. Results of viscocanalostomy and incidence of goniopuncture were retrospectively investigated in 33 eyes of 33 patients. Success was defined as an intraocular pressure (IOP) below 19 mmHg with an at least 30% decrease compared to the last preoperative measurement. General success rates after a mean follow-up of 33.5 +/- 11.3 months were 79 and 46%, with and without medications, respectively. Mean IOP levels, which were 37.7 +/- 9.9 mmHg at the diagnosis without treatment and 27.7 +/- 11.3 mmHg at the last preoperative measurement with medical treatment, significantly decreased to 12.7 +/- 4.8 mmHg at the last follow-up visit (P < 0.001 for both comparisons). Twelve eyes (36%) with IOPs higher than 18 mmHg during follow-up underwent laser goniopuncture. Mean IOP, which was 26.0 +/- 4.6 mmHg before goniopuncture, decreased to 11.5 +/- 4.0 mmHg immediately after the procedure (P = 0.002). Early goniopunctures (before month 3) were performed in six eyes, and late goniopunctures (after month 10) were performed in the remaining six eyes. Success rates of laser-applied eyes at the last visit were 75 and 33%, with and without medications, respectively (P = 0.568). No significant difference was found between eyes with and without goniopunctures in terms of success rates, IOP levels, and IOP reduction rates. According to the results of this study, laser goniopuncture is indicated in a significant proportion of patients following viscocanalostomy and may substantially improve the outcome of surgery.