LAUSR

PRCIS Laser goniopuncture is an effective outpatient procedure which has been shown to maintain reduced intraocular pressure 5 years following initial laser treatment in patients who have had viscocanalostomy (with or without phacoemulsification). PURPOSE To establish the long term (5 year) efficacy of neodymium-doped:yttrium aluminium-garnet laser goniopuncture to lower intraocular pressure following viscocanalostomy or phacoviscocanalostomy in patients with glaucoma. PATIENTS AND METHODS This retrospective study analysed patients who underwent laser goniopuncture following viscocanalostomy+/-phacoemulsification between 2009 to 2012 at the Stanley Eye Unit in Abergele. Reason for further intervention included either increasing intraocular pressure outside target range or worsening visual fields. Statistical analyses were performed comparing pre-goniopucture values to those taken up to 5 years later. RESULTS Of the 620 viscocanalostomy and phacoviscocanalostomy procedures performed between 2009-2012, 218 eyes underwent laser goniopuncture after a mean of 25 months [95% CI 22.58-27.41] following surgery. Patients having a phacoviscocanalostomy had a longer mean time to goniopuncture compared to those who were phakic and had viscocanalostomy only (P<0.001). Immediately following goniopuncture intraocular pressure dropped, and a statistically significant reduction persisted at 5 year follow-up (P<0.001). Goniopuncture reduced intraocular pressure significantly from a pre-treatment value of 21▒mmHg to 15mmHg over 5 years (95% CI) (X2F(4)=119.1, P<0.001). In total, 154 eyes (71%) were commenced on IOP-lowering medication at a mean of 14 months (95% CI 12-17). At 5 years, successful IOP control was achieved in 73% (49 out of 67) of eyes. There was no difference found between type of surgery and successful pressure control at 5 years (X2(1)=2.00, P=0.16). CONCLUSIONS Laser goniopuncture is an effective procedure which maintains a statistically significant reduction in intraocular pressure in the long term.