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The presence of iris synechiae or incarceration in the goniopuncture was the only factor significantly associated with failure of LGP by regression analyses (hazard ratio see more 3.0; p?<?0.001) and log-rank test. Complications seen after LGP are detailed in Table?3. The most common of these was iris synechiae, which occurred in 23 eyes (13.2%). Other complications included hypotony in seven (4.0%), late acute IOP rise in three (1.7%) and delayed bleb leak and blebitis in one and two eyes, respectively. Subsequent procedures are shown in Table?4. By last follow-up, 29 patients (16.7%) were on medications to control IOP and the mean number of medications was 0.3????0.7. A summary of the final treatment outcomes in eyes undergoing LGP is depicted in Fig.?5. The study is retrospective in design. This necessarily resulted in a heterogeneous group of patients with a variety of pre-existing ocular pathology and surgical strategies. Laser goniopuncture was carried out at an arbitrary IOP level with the aim of lowering IOP into the low teens. Setting lower target IOP levels has implications, as evidenced by a high frequency of postoperative manipulations after DS, including LGP. In a prospective study, Mermoud et?al. (1999a) reported an LGP rate of 41% with an immediate success rate of 83% in lowering pressure in eyes with primary DS. The mean interval between DS and LGP was 9.9?months. The operated eyes were at a low risk for failure and mean IOP dropped from 22.2????7.0?mmHg to 12.6????3.8?mmHg at 12?months. The follow-up was short, with www.selleckchem.com only 19 of the 41 eyes completing a year??s follow-up. Complications were limited to choroidal detachment in two eyes. In a large retrospective study of primary DS, Lachkar et?al. (2004) reported an LGP rate of 47.3% Forskolin after a mean follow-up of 54????17?months. They also performed argon iridoplasty in 10% of cases. Likewise, in a longterm study of a heterogeneous group of eyes undergoing DS, Detry-Morel & Detry (2006) reported a 63% goniopuncture rate with a final mean IOP of approximately 15?mmHg after LGP. A review of the literature shows reported rates of LGP vary from 4.7% to 63.0% (Mermoud et?al. 1999a; Shaarawy et?al. 2001; Ambresin et?al. 2002; Wishart et?al. 2003; Anand & Atherley 2005; Khairy et?al. 2005; Detry-Morel & Detry 2006; Drolsum 2006; Rekonen et?al. 2006). A recent review of all papers relating to non-penetrating glaucoma surgeries suggests that as the IOP-lowering effect of LGP has become apparent, postoperative LGP rates have increased, and that success rates for DS seem to be lower when the LGP rate is low (Sarodia et?al. 2007). It should be noted that eyes which underwent LGP after DS in this study had a significantly longer follow-up than eyes which had not yet undergone LGP.
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