title: Nd:Yag laser goniopuncture for deep sclerectomy: efficacy and outcomes.
abstract: OBJECTIVE
  To report on the safety and efficacy of Nd: YAG laser goniopuncture (LGP) for postsurgical intraocular pressure increase after deep sclerectomy (DS) in a consecutive cohort of open-angle glaucoma patients.
  
  
  METHODS
  This case series included 56 eyes from 49 consecutive patients who underwent LGP between November 2008 and March 2015. Prior to LGP, patients had undergone DS augmented with mitomycin C and injectable cross-linked hyaluronic acid implant between October 2008 and May 2014. Demographic variables, type of glaucoma, prior phacoemulsification, intraocular pressure (IOP), best-corrected visual acuity, execution of post-LGP maneuvres, and post-LGP complications were analyzed. The success rate of the procedure was analyzed using the Kaplan-Meier survival curve. Univariate and multivariate analyses were performed using the Cox proportional hazard regression model in order to highlight variables associated with a failure to achieve surgical success.
  
  
  RESULTS
  Mean IOP was 23.0 mmHg prior to LGP, and 12.5, 11.8, and 10.5 mmHg at 6, 12, and 24 months after LGP respectively. Post-laser IOP was significantly lower than pre-laser IOP at every time point. For an IOP ≤ 15 mmHg, success rates were 85 % at 6 months, 76 % at 1 year, and 62 % at 2 years. Thirty-eight eyes underwent prophylactic iridotomy and iridoplasty prior to LGP. Iris prolapse into the trabeculo-descemetic window following LGP occurred in 6/18 eyes (33.3 %) of the non-pretreated and in 1/38 eyes (2.6 %) of the pretreated group. One case of choroidal detachment and one delayed suprachoroidal hemorrhage occurred after LGP execution in two non-pretreated eyes.
  
  
  CONCLUSIONS
  LGP is a relatively safe and effective complementary adjunct to deep sclerectomy that makes it possible to further lower IOP and avoid additional filtering surgery. Prophylactic iridotomy and localized iridoplasty may permit the frequency of post-LGP complications to be reduced.
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy. dimatteo.federico@hsr.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Di Matteo
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Bettin
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Fiori
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Ciampi
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rabiolo
authors.affiliation: Department of Ophthalmology, San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina 60, 20132, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Bandello
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005902:Glaucoma, Open-Angle / Q000503:physiopathology / Q000601:surgery*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D032801:Iridectomy; D053685:Laser Therapy; D053844:Lasers, Solid-State; D008297:Male; D008875:Middle Aged; D011677:Punctures; D012189:Retrospective Studies; D012599:Sclerostomy / Q000379:methods*; D014065:Tonometry, Ocular; D014129:Trabecular Meshwork / Q000601:surgery*; D014792:Visual Acuity / Q000502:physiology
keywords: Deep sclerectomy; Glaucoma; Goniopuncture; Iridoplasty; Iridotomy; Iris prolapse
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