title: Internal and transconjunctival neodymium:YAG laser revision of late failing filters.
abstract: Seven cases of hypofunctioning trabeculectomies or full-thickness filters were treated using the Q-switched neodymium:YAG (Nd:YAG) laser delivered either transconjunctivally, gonioscopically, or by a combination approach. In four eyes, internal laser revision was attempted initially. Internal revision was successful in one case, where the sclerostomy had become occluded by a fibrous membrane. The Nd:YAG laser was then focused transconjunctivally onto the episcleral fibrous tissue within the bleb in the three eyes treated unsuccessfully by the internal approach and used as a primary treatment in three additional cases. Transconjunctival laser treatment was successful in producing an immediate and substantial decrease in intraocular pressure (IOP) (mean IOP reduction of 12 mmHg at 2 hours posttreatment) in all cases. In six of seven cases, there was a persistent reduction of intraocular pressure with an average of 5.7 months of follow-up. Transconjunctival Nd:YAG laser revision of hypofunctioning filters may be effective in restoring filtration in selected cases.
authors.affiliation: Beetham Eye Institute, Joslin Clinic, Massachusetts General Hospital, Boston 02114.
authors.forename: M A
authors.initials: MA
authors.lastname: Latina
authors.forename: G A
authors.initials: GA
authors.lastname: Rankin
mesh_terms: D000368:Aged; D003228:Conjunctiva; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000601:surgery*; D005902:Glaucoma, Open-Angle / Q000601:surgery*; D006801:Humans; D007429:Intraocular Pressure; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012590:Sclera / Q000601:surgery*; D012599:Sclerostomy; D014130:Trabeculectomy