COMPARISON OF THE EFFICACY OF ER-YAG LASER SCLEROSTOMY AB EXTERNO VERSUS TRABECULECTOMY IN THE TREATMENT OF PATIENTS WITH PRIMARY OPEN-ANGLE GLAUCOMA

Purpose: This study was conducted to compare the efficacy of the Er-YA G laser sclerostomy ab externo versus trabeculectomy in the treatment of primary open - angle glaucoma. Methods: Twelve patients with POAG u nderwent ab externo laser sclerostomy using an Er-YAG laser (Sklerosto m 2.9(R); lambda = 2940 nm, t = 200 mu s, 2 Hz, 400 mu m, 15 mJ). Only local medication was used, and there were no risk factors for failure . As a control group 12 patients out of 248 standardized trabeculectom ies were matched in terms of age, sex, diagnosis and local medications . No antimetabolites were used in either group. Results: After a follo w-up of 9 months in the sclerostomy group 53%; (7/12; P = 0.03) showed a patent fistula in comparison of 100% in the trabeculectomy group. T here was a significantly lower mean IOP during the first postsurgical week in the group of sclerostomies (3.6 +/- 1.5 mmHg versus 7.5 +/- 2. 7 mmHg; P = 0.0001) with a higher incidence of choroidal detachments ( 9/12 versus 2/12; P = 0.004). The choroidal detachments lasted longer in the sclerostomy group (3.5 months versus 0.3 months; P = 0.014). Ir is incarcerations were found only in sclerostomies (7/12; P = 0.05). C onclusions: Based on these findings, Er-YAG laser sclerostomy prooved to be less effective than trabeculectomy in the treatment of glaucoma patients. Er-YAG laser sclerostomies were associated with a higher inc idence of postsurgical complications such as hypotony, choroidal detac hments and iris incarcerations. At this point Er-YAG laser sclerostomy is not superior to conventional trabeculectomy.