Laser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failure. Issue 1 (20th July 2021)

• Record Type: Journal Article
• Authors: Rabiolo, Alessandro; Leadbetter, Duncan; Kirk, Jonathan; Anand, Nitin
• Is Part Of: British journal of ophthalmology. Volume 107:Issue 1(2023)
• Page Start: 56
• Page End: 61
• Publication Date: 2021-07-20
• Subjects: glaucoma -- treatment surgery -- treatment lasers; Ophthalmology -- Periodicals; 617.7
• DOI: 10.1136/bjophthalmol-2021-319314
• Languages: English
• ISSNs: 0007-1161

Abstract

Abstract : Aims: To report the incidence, risk factors and long-term outcomes of laser goniopuncture (LGP) in patients with previous deep sclerectomy (DS). Methods: Retrospective cohort study of 1765 eyes (1385 patients) undergoing DS with or without cataract surgery between 2001 and 2020 in two UK institutions. Kaplan-Meier was used to estimate LGP incidence. DS success after LGP was calculated for criteria A, B, and C defined as intraocular pressure (IOP) of ≤18, ≤15 and ≤12 mm Hg with 20%, 25% and 30% reduction, respectively. Cox regression was used to investigate factors associated with the risk of failure. Results: LGP had an estimated incidence of 33.3% (30.9%–35.6%), 56.3% (53.5%–58.9%) and 62.8% (59.7%–65.6%) at 1, 3, 5 years, respectively. Mean (±SD) IOP significantly (p<0.001) decreased from 21.2 (±6.0) mm Hg pre-LGP to 13.8 (±5.2) mm Hg and 12.9 (±4.7) mm Hg at 3 and 5 years post-LGP, respectively. Success rates at 3 and 5 years were, respectively, 40.9% (37.5%–44.6%) and 33.7% (30.3%–37.6%) for criterion A; 27.1% (24.0%–30.5%) and 22.3% (19.3%–25.7%) for criterion B and 13.9% (11.6%–16.7%) and 11.6% (9.5%–14.3%) for criterion C. In all models, higher pre-LGP IOP (p<0.001) and higher pre-LGP medication number (p<0.001) were associated with increased failure, while male gender (p≤0.004), intraoperative mitomycin C (p≤0.031), longer interval between DS and LGP (p≤0.01) with reduced failure. Conclusion: Most patients undergoing DS will eventually require LGP. LGP is effective at rescuing eyes with a failing DS. This study identifies several factors associated with LGP outcomes, knowledge of which may help clinicians predict LGP success.