Gonioscopic sclerostomy using laser ablation of dyed sclera in refractory glaucoma

S. Melamed*, A. Solomon, D. Neumann, M. Blumenthal, M. Belkin

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Eighteen eyes of 18 patients with refractory glaucoma were treated with internal sclerostomy using laser ablation of dyed sclera. The procedure includes iontophoresis of the sclera at the limbal region with 1% methylene blue and subsequent delivery of a pulsed dye laser beam to the stained area through a goniolens. The red wavelength of 664 nanometers emitted by the laser is maximally absorbed by the stained sclera and creates a through and through scleral perforation. Successful complete sclerostomy was achieved in ten eyes (55.5%) and was associated with a reduction of intraocular pressure in all cases. Mean pre-laser intraocular pressure was 48.8 mm Hg and one hour after therapy it was reduced to 18.7 mm Hg. At the end of the follow-up period (mean: seven months), mean intraocular pressure was 27.6 mm Hg, eight eyes had maintained their intraocular pressure below 22 mm Hg (44%) and the medication index had dropped from 2.9 to 2.3 per eye. There were two cases of hyphema, one case of transient IOP spike and one case of transient retinal flame shaped hemorrhage. No iridodialysis or retinal detachment were detected. Ab-interno sclerostomy of methylene blue dyed sclera in glaucoma patients is technically feasible and the preliminary results of intraocular pressure control in refractory glaucoma are promising. Improvement of efficiency of scleral perforation is needed, and modifications of the iontophoresis process, gonioscopic lens design and laser parameters are currently under way in an attempt to achieve this goal.

Original languageEnglish
Pages (from-to)181-189
Number of pages9
JournalLasers and Light in Ophthalmology
Issue number3-4
StatePublished - 1992
Externally publishedYes


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