Evaluation of laser results laser goniopuncture after deep sclerectomy for open angle glaucoma treatment

BACKGROUND: Laser goniopuncture with Nd:YAG laser is an adjunctive procedure to create an additional drainage channel through Descemet’s membrane to maintain effective intraocular pressure reduction after deep sclerectomy. Although several studies have evaluated the effectiveness of laser goniopuncture after deep sclerectomy in Vietnam, there is still not much specific research data on the success rate, duration of efficacy, and prognostic factors.

AIM: Evaluate the effectiveness of laser goniopuncture after deep sclerectomy in managing intraocular pressure (IOP) in patients with open-angle glaucoma.

METHODS: A prospective clinical interventional study was conducted on 16 eyes of 16 patients with primary open-angle glaucoma who had undergone deep sclerectomy but exhibited inadequate IOP control. Laser goniopuncture was performed using an Nd:YAG laser. Patients were followed for three months with assessments at 1 day, 1 week, 1 month, and 3 months post-laser. Primary outcomes included IOP reduction, absolute and relative success, and failure rates based on AGIS VII criteria. Secondary outcomes included the proportion of patients no longer requiring IOP-lowering medication, visual acuity changes, and ultrasound biomicroscopy evaluation of bleb height.

RESULTS: Laser goniopuncture significantly reduced IOP from 26.69 mmHg pre-laser to 12.31 mmHg after 1 day (p < 0.001), with stable control over three months. The success rate remained high (85–95%), and 87.5% of patients achieved an IOP reduction of ≥ 30%. The proportion of patients who no longer required IOP-lowering medication increased significantly from 0% pre-laser to 93.8% at one month. Visual acuity improved without severe complications. Ultrasound biomicroscopy showed a significant increase in bleb height post-laser, correlating with IOP reduction. Only 6.2% of patients experienced mild hyphema, which resolved spontaneously.

CONCLUSION: Laser goniopuncture is an effective and safe adjunctive procedure following deep sclerectomy for managing IOP in open-angle glaucoma patients. It reduces medication dependence and maintains stable IOP without severe complications. However, long-term follow-up is necessary to assess its prolonged efficacy.