Photoablative filtration surgery with the excimer laser for primary open-angle glaucoma: a pilot study.
We have performed ab-externo photoablative filtration surgery on 19 patients affected by uncontrolled primary open-angle glaucoma. All cases had wide open angles, were previously treated with argon laser trabeculoplasty and were considered good candidates for trabeculectomy. After topical and peribulbar anesthesia, a limbus-based conjunctival flap was dissected. Photoablation of a rectangular area at the limbus was performed with an argon fluoride excimer laser (193 nm), at 180 mJ x sq cm fluence. The beam was shaped in the appropriate fashion using a custom-made metal mask. Photoablation was continued until aqueous appeared percolating through the juxtacanalicular tissue at the bottom of the crater; a water-tight closure of conjunctiva was then performed. Postoperatively, the anterior chamber reaction was minimal; in no case a flat chamber or choroidal detachment was observed. In 18 of the 19 cases the IOP was significantly lowered, and a filtering bleb developed. Mean preoperative IOP was 26.4 (+/- 7) mmHg. At a median follow-up of 9 months (range 4-15) the IOP is < or = 18 mmHg on no medications in 16 (84%) of the eyes, with a mean value of 13.3 (+/- 6) mmHg. Our short-term results support excimer laser photoablative filtration as a relatively safe and effective procedure for primary open-angle glaucoma.
Traverso
C E
CE
Clinica Oculistica dell Universita, San Marino, Genova, Italy.
Murialdo
U
U
Di Lorenzo
G
G
Venzano
D
D
De Palma
G
G
Gandolfo
E
E
Calabria
G A
GA
Zingirian
M
M
D000368:Aged; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D017075:Laser Coagulation; D008875:Middle Aged; D010865:Pilot Projects; D011183:Postoperative Complications; D011446:Prospective Studies; D012590:Sclera / Q000601:surgery; D013524:Surgical Flaps; D014130:Trabeculectomy