title: [Post-surgical treatment after non-penetrating glaucoma surgery: the goniopuncture].
abstract: Non-penetrating glaucoma surgery was primarily developed as an alternative to the widely applied trabeculectomy. Since the anterior chamber in non-penetrating surgery is not directly opened, common postoperative complications such as hypotony are rare. The most frequently applied technique in this group is the deep sclerectomy. After having prepared a superficial scleral flap a deeper scleral flap is performed and excised unroofing Schlemm's canal. The trabecular meshwork is then peeled leaving a residual trabeculodescemet membrane. As a consequence aqueous humour diffuses via the trabeculodescemet membrane under the scleral flap and subsequently under the conjunctiva. One of the reasons for a postoperatively high IOP is seen in the resistance of the residual trabculodescemet membrane. A solution to this problem lies in its puncture, the so-called goniopuncture. Goniopunctures are done in approximately 50 % of cases after deep sclerectomy and are also applied in cases of canaloplasty and viscocanaloplasty. Usually a 1064 nm Nd : YAG laser is used. A potential risk of iris incarceration is described. Two studies have shown that an equally IOP lowering effect can be achieved by treating the trabeculodescemet membrane with a frequency-doubled 532 nm Nd : YAG laser (SLT). No complications were detected in those cases. In conclusion, goniopuncture should be considered as the first line treatment for postoperative IOP increase in cases of non-penetrating glaucoma surgery. It should therefore be preferred to a (re)start of topical treatment.
authors: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
authors: C
authors: C
authors: Gesser
authors: Klinik und Poliklinik für Augenheilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg.
authors: M
authors: M
authors: Klemm
mesh_terms: D003886:Descemet Membrane / Q000601:surgery*; D005901:Glaucoma / Q000601:surgery*; D006801:Humans; D053685:Laser Therapy / Q000379:methods; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D009798:Ocular Hypertension / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*; D011677:Punctures / Q000379:methods*; D012086:Reoperation; D012590:Sclera / Q000601:surgery*; D014130:Trabeculectomy / Q000379:methods*