[Gonioretraction using argon laser].
Argon laser trabeculoplasty (ALT) has recently become one of the most popular procedures in the treatment of chronic open angle glaucoma. Although ALT is quite efficient, its mode of action is far from understood and the rate of complications or side effects is not negligible. In 1981 we began exploring a different procedure that we have called argon laser gonioretraction (ALG) with reference to the Cairns surgical goniospasis. While the corneo-scleral trabeculum is the target for argon laser beams in ALT, in ALG the beams are directed toward the ciliary band in an attempt to get the scar to pull the scleral spur backwards and stretch the trabeculum. The procedure may also act through the uveal trabeculum. The procedure was first utilized from 1981 to 1983 in 43 chronic open angle glaucoma eyes with: 1/ a high rate of success in decreasing the intraocular pressure on a long term basis, 2/ an acceptable rate of complications. 18 months after laser surgery, intraocular pressure was fully controlled without any medical treatment in 19 cases (44%). 18 additional cases (42%) were controlled with the help of less medical treatment than before. In 4 cases (8%) the failure was complete including one case with significant prolonged and non-responsive post-op hypertension which has induced a slight alteration of the visual field. One case was lost to follow-up. Supposed advantages of ALG over ALT are: integrity of the corneo-scleral trabeculum is maintained, goniosynechiae are more peripheral, and there is less propensity to induce proliferation of endothelial cells.
D000328:Adult; D000368:Aged; D000867:Anterior Chamber / Q000601:surgery; D002924:Ciliary Body / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D053685:Laser Therapy; D007834:Lasers / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012590:Sclera / Q000473:pathology; D014129:Trabecular Meshwork / Q000473:pathology / Q000601:surgery
La goniorétraction au laser à argon.