Neodymium:YAG Laser Trabeculopuncture in Juvenile Open-Angle Glaucoma

The authors performed neodymium:YAG (Nd:YAG) laser trabeculopuncture (YLT) in eight eyes of six patients with uncontrolled juvenile openangle glaucoma. Two methods of treatment were evaluated: (1) either two confluent trabeculotomies, each 1 clock hour in extent; or (2) focal treatment in four quadrants. In six eyes (75%), the intraocular pressure (IOP) was controlled (≤ 19 mmHg) after a mean follow-up period of 6 ± 2 months. All successful treatments were associated with blood reflux from the site of trabeculopuncture into the anterior chamber at the time of the procedure. Energy levels required for a single trabeculotomy (1 clock hour in extent) and for one focal trabeculopuncture, were 156 ± 59 mJ and 42 ± 24 mJ, respectively. The clinical results suggested that confluent trabeculotomy may be superior to focal treatment. No major complications were encountered with either treatment. The authors propose the use of YLT in uncontrolled juvenile glaucoma before surgically invasive goniotomy or filtration operations.