Laser goniopuncture effective in rescuing eyes after failed deep sclerectomy: Study

UK: A new study in the British Journal of Ophthalmology pointed out that laser goniopuncture (LGP) is a reliable technique to rescue eyes in case of failure of deep sclerectomy (DS). However, the research adds that there are several factors that might affect its success or failure, identifying those factors might help clinicians to predict LGP success. 

The study further states that most patients undergoing DS will eventually require LGP.

Intraocular pressure (IOP) control after non‐penetrating deep sclerectomy is the most crucial aspect. Deep sclerotomy acts at the bulk of main resistance to aqueous humor egress. Previous studies have shown laser goniopuncture to be an effective procedure to further lower IOP after DS. Alessandro Rabiolo, Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK, and colleagues aimed to report the incidence, risk factors and long-term outcomes of laser goniopuncture in patients with previous deep sclerectomy.

For this purpose, the authors conducted a retrospective cohort study in 1765 eyes (1385 patients) undergoing DS with or without cataract surgery between 2001 and 2020 in two UK institutions. LGP incidence was estimated using Kaplan-Meier. DS success after LGP was calculated for criteria A, B, and C defined as intraocular pressure (IOP) of ≤18, ≤15 and ≤12 mm Hg with 20%, 25% and 30% reduction, respectively. Cox regression was used to investigate factors associated with the risk of failure.

The results of the study were found to be:

• LGP incidence was estimated and found in 33.3%, 56.3%, and  62.8% at 1st, 3rd, 5th year, respectively.

• Mean IOP was seen to be significantly decreased from 21.2 mm Hg pre-LGP to 13.8 mm Hg and 12.9 mm Hg at 3 and 5 years post-LGP,

• Success rates were seen at 3 and 5 years respectively, 40.9% and 33.7% for criterion A; 27.1% and 22.3% for criterion B and 13.9% and 11.6% for criterion C.

• In all models, it was seen higher pre-LGP IOP and higher pre-LGP medication numbers were associated with increased failure, while male gender, intraoperative mitomycin C, longer interval between DS and LGP with reduced failure.

Rabiolo and the team concluded that " Most patients undergoing DS will eventually require LGP. LGP is effective at rescuing eyes with a failing DS. This study identifies several factors associated with LGP outcomes, knowledge of which may help clinicians predict LGP success."

Reference:

Rabiolo A, Leadbetter D, Kirk J, et alLaser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failureBritish Journal of Ophthalmology Published Online First: 20 July 2021. doi: 10.1136/bjophthalmol-2021-319314