title: Nd:YAG laser goniopuncture for late bleb failure after trabeculectomy with adjunctive mitomycin C.
abstract: OBJECTIVE
  There is an increasing need to prolong trabeculectomy success rates with minimally invasive procedures.
  
  
  OBJECTIVE
  To investigate the safety and efficacy of Nd:YAG laser goniopuncture (LGP) in lowering intraocular pressure (IOP) in eyes having late bleb failure following trabeculectomy with mitomycin C administration.
  
  
  METHODS
  Prospective, noncomparative, interventional cohort at a referral glaucoma practice, including 19 eyes of 19 patients with uncontrolled glaucoma after failed trabeculectomy.
  
  
  METHODS
  All eyes had ischemic nonfunctioning blebs with patent internal ostia and underwent Nd:YAG LGP, followed by a 5-fluorouracil injection.
  
  
  METHODS
  The IOP and the number of antiglaucoma medications before and after the procedure, as well as presurgical and postsurgical appearance of the blebs, using the Indiana Bleb Appearance Grading Scale classification.
  
  
  RESULTS
  The mean (SD) time of LGP after trabeculectomy was 35.7 (32.3) months, and the mean (SD) follow-up period after LGP was 6.0 (1.1) months (range, 4.4-8.4 months). The mean (SD) IOP had decreased from 20.9 (4.5) mm Hg (range, 15.5-29.0 mm Hg) to 11.9 (4.1) mm Hg (range, 5.0-21.0 mm Hg) (P < .001). The only complications observed after LGP were 2 cases of hypotony, which resolved spontaneously. Compared with baseline Indiana Bleb Appearance Grading Scale classifications, 2 eyes showed an increase in bleb height and 10 eyes showed an increase in bleb extension. None of the eyes had a positive Seidel test result. The mean (SD) number of hypotensive agents per eye had decreased from 0.7 (1.1) to 0.3 (0.7) after the procedure. At the last follow-up visit, 15 eyes (79%) had achieved an IOP of 15 mm Hg or less, with a minimum IOP reduction of 20% from baseline without medication use.
  
  
  CONCLUSIONS
  The Nd:YAG LGP is a safe and effective procedure for lowering IOP in eyes with ischemic nonfunctioning blebs and patent trabeculectomy ostia. This is a promising solution to rescue failed trabeculectomies and can potentially prolong trabeculectomy success rates.
authors.affiliation: Department of Ophthalmology, University of São Paulo, São Paulo, Brazil.
authors.forename: Remo
authors.initials: R
authors.lastname: Susanna
authors.affiliation: The Shelley and Steven Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York3Department of Ophthalmology, New York University School of Medicine, New York.
authors.forename: Carlos G
authors.initials: CG
authors.lastname: De Moraes
authors.affiliation: Department of Ophthalmology, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciana M
authors.initials: LM
authors.lastname: Alencar
authors.affiliation: The Shelley and Steven Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York.
authors.forename: Robert
authors.initials: R
authors.lastname: Ritch
mesh_terms: D000368:Aged; D000477:Alkylating Agents / Q000008:administration & dosage*; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005901:Glaucoma / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D053685:Laser Therapy; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage*; D011446:Prospective Studies; D011677:Punctures / Q000379:methods; D019738:Surgically-Created Structures; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000601:surgery; D014130:Trabeculectomy; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000477:Alkylating Agents; D016685:Mitomycin; D005472:Fluorouracil