Safety and efficacy of combined Nd:YAG laser goniopuncture after non-penetrating deep sclerectomy: results of a cohort study

Non-penetrating deep sclerectomy (NPDS) is one of the safest and most effective surgical treatments for glaucoma. Nd:YAG laser goniopuncture (LGP) as a mandatory adjuvant procedure is associated with a significant risk of delayed complications.

Purpose of the study: to evaluate the clinical efficacy and safety of a combined technique of LGP after non-penetrating deep sclerectomy compared to a control group.

Materials and methods. A retrospective cohort study was conducted in 2 groups of patients with primary open-angle glaucoma who underwent NPDS followed by LGP between 2016 and 2021. In the main group, a microfistula was formed in the superolateral part of the trabeculodescemet membrane (TDM). In the control group, LGP was performed in the central part of the TDM. The primary endpoint to evaluate the efficacy of the technique was the maintenance of complete surgical success of NPDS at 6, 12, 18, 24 months after LGP compared to the control group. The safety endpoint was the number and outcome of postoperative complications.

Results. 71 patients were included in the main group and 63 patients in the control group. At the end of 2 years of follow-up, 55 (77 %) patients in the main group maintained complete surgical success of NPDS, while in the control group — 39 (62 %) patients (χ2 = 3.870, p = 0.049). In the main group, the Kaplan — Meier survival analysis showed statistically significant greater odds of maintaining surgical success of NPDS after LGP (p = 0.032). In the main group, 3 out of 71 patients (4.2 %) developed microfistula blockage by the iris root, in all cases the complications were resolved by laser reconstruction of the surgical field. In the control group, microfistula blockage was described in 11 out of 63 (17.5 %) cases (p = 0.012), in 1 case it was resolved during laser reconstruction of the intervention area, 6 patients were treated with hypotensive eye drops, 4 patients underwent surgical intervention.

Conclusions. The combined technique of LGP and risk-oriented approach to patient monitoring significantly reduces the incidence of complications, ensures their early detection and allows to manage their consequences through non-invasive treatment methods. As a result, the probability of maintaining complete surgical success of NPDS during 2-year follow-up is increased, which improves the long-term prognosis for vision preservation in glaucoma patients.

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