Goniopuncture After Non-Penetrating Deep Sclerectomy: Too Early or Too Late

Abstract

INTRODUCTION: Non-penetrating deep sclerectomy is a non-penetrating glaucoma surgery with growing interest in recent years. In this procedure, a new pathway for aqueous humor outflow is created, while preserving the integrity of the anterior chamber. If satisfactory intraocular pressure is not achieved, postoperative neodymium-yttrium-aluminum-garnet laser goniopuncture can restore aqueous outflow through the trabeculo-Descemet’s membrane. Although considered a safe procedure, some complications, such as iris incarceration, have been reported. The purpose of the study is to investigate the efficacy and safety of goniopuncture in lowering IOP after surgery and to determine if there is a significant difference in outcomes based on whether the procedure is performed early or late after surgery.
METHODS: In this retrospective study, patients submitted to goniopuncture following deep sclerectomy at Unidade Local de Saúde de Matosinhos between July 2015 and July 2022 were analyzed. We recorded demographic variables, type of glaucoma, prior phacoemulsification, intraocular pressure, best-corrected visual acuity, number of glaucoma medications, time between surgery and goniopuncture, number of goniopunctures performed, success of goniopuncture, and post-goniopuncture complications. Patients were followed-up for two years.
RESULTS: Out of 220 eyes submitted to deep sclerectomy, goniopuncture was performed in 56 eyes (25.45%) of 56 patients with a median interval of 4.50 (11) months. Early goniopuncture (≤3 months after surgery) was performed in 27 eyes (48.2%) and late goniopuncture (>3 months after surgery) in 29 eyes (51.8%). At last follow-up, the success rate was 75% (n=42). Intraocular pressure showed a significant reduction from 22.34±6.15 mmHg before goniopuncture to 12.73±4.68 mmHg immediately after the procedure (p<0.001) and 14.57±3.67 mmHg at 24 months (p<0.001). No significant difference was found between early and late goniopuncture in the success rate of intraocular pressure reduction (74.1% vs 75.9%, p=0.880). The most common complication recorded was iris incarceration (n=5, 8.9%), followed by hypotony (n=2, 3.6%). At last evaluation, a significant reduction on mean number of medications was observed (0.84±0.16, p<0.001).
CONCLUSION: Goniopuncture is effective in reducing intraocular pressure long-term, with similar outcomes whether performed early or late after surgery. Despite being generally safe, complications like iris incarceration require careful postoperative monitoring.