Q-switched neodymium-YAG laser angle surgery in open-angle glaucoma.

In a short-term pilot study, we evaluated Q-switched neodymium-YAG laser angle surgery in 25 eyes from 22 patients with medically uncontrolled open-angle glaucoma. All eyes had unacceptable intraocular pressures (IOPs), despite maximum tolerated medical therapy, argon laser trabeculoplasty, and prior intraocular filtration surgery (eight eyes). Using a pulse energy of 10 millijoules, ten spots were placed approximately 4 degrees apart in the mid-trabecular meshwork using an Nd-YAG laser (Coherent 9900). The mean preoperative and final postoperative IOPs were 30 +/- 6 mm Hg and 21 +/- 8 mm Hg, respectively. The mean follow-up time was five (+/- 3) months (range, two to 14 months). The final postoperative IOP was less than 22 mm Hg in 17 eyes (68%). Holes within the trabecular meshwork were visible in 14 eyes, and laser therapy was associated with the liberation of debris into the anterior chamber in all eyes. Complications included transient postoperative IOP elevation (eight eyes), angle bleeding (six eyes), and posterior displacement of the iris root (four eyes).