Korean J Ophthalmol > Epub ahead of print
DOI: https://doi.org/10.3341/kjo.2020.0050    [Epub ahead of print]
Published online December 11, 2020.
Effect of Nd:YAG Laser Goniopuncture Timing on the Long-term Efficacy of Non-penetrating Deep Sclerectomy
Natalia Volkova1,2,3, Andrey Shchuko1,2,3
1Irkutsk Branch of S. Fyodorov Eye Microsurgery Federal State Institution 337 Lermontov str., Irkutsk, 664000, Russian Federation
2Irkutsk State Medical University, 8 3rd July str. Irkutsk, 664000, Russian Federation
3Irkutsk State Medical Academy of Postgraduate Education, 16 Surikov str., 664000, Irkutsk, Russian Federation
Correspondence:  Natalia Volkova, Tel: +7 9526322545, 
Email: volkova.natalia.irk@gmail.com
Received: 16 April 2020   • Revised: 12 October 2020   • Accepted: 19 October 2020
Abstract
Purpose
To report on impact of Nd:YAG laser goniopuncture (LGP) timing on hypotensive efficacy of deep sclerectomy (DS) for open-angle glaucoma (OAG).
Methods
228 patients who underwent DS followed by LGP between January 2010 and December 2013, (follow up – 5 years) were enrolled into a single-center, retrospective, non-randomized, consecutive study. Subjects were divided into two groups (1 – delayed LGP, n=116; 2 – early LGP, n=112). Intraocular pressure (IOP), ultrasound biomicroscopy (UBM) values, DS and LGP intraoperative and postoperative complications were recorded. The criteria for early LGP were higher density and increased thickness of the Trabeculo-Descemet membrane (TDM), as well as decreased height of the intrascleral channel and the height of the scan by UBM monitoring. IOP elevated above the target values was also a criterion in the delayed LGP group. Complete success was defined as IOP ≤ 15 mm Hg.
Results
LGP was performed 3.46±1.9 (1.5-6.7) months after in group 1, 1.12±0.08 (0.9-1.5) months after in group 2. IOP lowered from 18.5±4.7 to 14.2±4.7 mm Hg in group 1 and from 15.7±4.1 to 12.15±1.9 mm Hg in group 2. Kaplan-Meier survival curve analysis showed a significant difference between groups for the target IOP ≤ 15 mm Hg (68.07% and 92.59% after 12 months, 40.7% and 75.8% after 24 months, 15.2% and 48.93% after 36, 48, 60 months respectively) p=0.0001.
Conclusion
Early LGP after DS excludes TDM influence on further formation of intrascleral cavity and outflow pathways demonstrating more pronounced hypotensive success in a long-term follow-up period.
Key Words: Deep sclerectomy, Nd:YAG laser goniopuncture, Glaucoma surgery, Trabeculo-Descemet membrane
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