Laser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failure
Kirk, Jonathan
Kirk, Jonathan
Date
2021-07-20
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Journal Article
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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.
Citation
Rabiolo, A., Leadbetter, D., Kirk, J., & Anand, N. (2023). Laser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failure. The British journal of ophthalmology, 107(1), 56–61. https://doi.org/10.1136/bjophthalmol-2021-319314