[Treatment of open angle glaucoma with deep sclerectomy combined with laser trabecular puncture].

OBJECTIVE: To study the effect of deep sclerectomy combined with laser trabecular puncture for the treatment of open angle glaucoma (OAG). METHODS: Deep sclerectomy was performed in 32 eyes of 32 patients with moderate to advanced stages of OAG. After the exposure of external wall of Schlemm's canal and the remaining trabecula, the intraocular optic fiber of diode laser photocoagulator was directed to the trabecula-limbus near the anterior edge of the scleral spur. Two or three punctures, approximately 0.5 mm in diameter, were performed with laser beam under direct visualization until aqueous humor was extravasated slowly. The scleral flap was closed with one or two sutures. Postoperative observation included intraocular pressure (IOP), intraocular tissue reaction, the appearance of filtering bleb, gonioscopy and ultrasound biomicroscopy. The follow-up period was 4 to 24 months (7.94 +/- 6.20) months. RESULTS: The anterior chamber was recovered shortly after the operation and the visual acuity remained the same in all eyes. At the end of follow-up period, the postoperative IOP (14.86 +/- 4.15) mm Hg was lower than the preoperative IOP (29.68 +/- 5.76) mm Hg, the difference was statistically significant (t = 7.415, P < 0.001). Diffuse and obvious filtering blebs were found in all eyes after the operation, including 27 functional blebs and 5 blebs that disappeared 2 to 3 months later. Iris was burned slightly in 2 cases, pigment was released and appeared in the anterior chamber temporarily. No laser injury occurred in the cornea and the lens. High IOP was found in 2 cases after long-term follow-up and could be controlled by antiglaucoma medication. CONCLUSIONS: Deep sclerectomy with laser trabecular puncture can effectively reduce the IOP, without the occurrence of serious complications that commonly seen after the trabeculectomy. It is an effective surgical method for the treatment of OAG.