Concave trabeculo-Descemet's membrane as an early sign of viscocanalostomy failure.
OBJECTIVE
To correlate trabeculo-Descemet's membrane (TDM) changes with a late rise in intraocular pressure (IOP) in patients with successful viscocanalostomy.


METHODS
Consultores Oftalmológicos, Hospital Oftalmológico Santa Lucía, and Centro de Estudios Médicos e Investigación, Buenos Aires, Argentina.


METHODS
Patients who had a viscocanalostomy between July 1998 and September 2001 were retrospectively studied. Gonioscopy was performed in all patients. A subgroup of patients who had a late increase in IOP and were successfully treated with neodymium:YAG (Nd:YAG) laser goniopuncture were studied to correlate gonioscopic findings. Ultrasound biomicroscopy was performed in 10 cases. Intraocular pressure measurements were taken before viscocanalostomy and before and after Nd:YAG treatment.


RESULTS
Sixty-eight eyes of 48 patients had a viscocanalostomy to control IOP. Twenty-six eyes had a late increase in IOP and were successfully treated with Nd:YAG laser goniopuncture. Before goniopuncture, 17 eyes (65.30%) had a concave TDM. The mean IOP in these patients increased from 14.27 mm Hg to 18.73 mm Hg (range 14 to 27 mm Hg). Goniopuncture was performed a mean of 10.7 months (range 1 to 36 months) after surgery. After Nd:YAG treatment, the TDM was flat in all patients who had a concave TDM before treatment. At the last examination, the mean IOP was 13.8 mm Hg, a mean decrease of 52.24% from the baseline preoperative IOP; 61.5% of eyes had a final IOP of 14.0 mm Hg or lower.


CONCLUSIONS
A concave TDM was associated with a late IOP rise. The TDM was flat after laser goniopuncture and normalization of IOP.
Negri-Aranguren
Ignacio C
IC
Consultores Oftalmológicos, Arenales 1611 Piso 4, 1061 Buenos Aires, Argentina. cinegriaranguren@consultoresoftalmologicos.com
Devoto
Martin
M
Dolzani
Dante
D
Izurieta y Sea
Soledad
S
Grigera
Daniel E
DE
Acosta
Jorge
J
D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D003886:Descemet Membrane / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D018463:Filtering Surgery / Q000379:methods*; D005901:Glaucoma / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D009798:Ocular Hypertension / Q000209:etiology / Q000601:surgery; D011677:Punctures; D012189:Retrospective Studies; D014129:Trabecular Meshwork / Q000000981:diagnostic imaging / Q000473:pathology*; D017211:Treatment Failure; D014463:Ultrasonography
D000959:Antihypertensive Agents