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Laser goniopuncture after deep sclerectomy: incidence, long-term outcomes and risk factors for failure
  1. Alessandro Rabiolo1,
  2. Duncan Leadbetter1,
  3. Jonathan Kirk1,
  4. Nitin Anand1,2
  1. 1Department of Ophthalmology, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK
  2. 2Department of Ophthalmology, Calderdale and Huddersfield NHS Foundation Trust, Huddersfield, West Yorkshire, UK
  1. Correspondence to Dr Alessandro Rabiolo, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, Gloucestershire, UK; rabiolo.alessandro{at}gmail.com

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.

  • glaucoma
  • treatment surgery
  • treatment lasers

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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Footnotes

  • Contributors Conception and design: AR. Analysis and interpretation: AR, DL, JK and NA. Data collection: NA and AR. Writing and revision: AR, DL, JK and NA. Manuscript approval: AR, DL, JK and NA. Overall responsibility: AR, DL, JK and NA.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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