Management of Pseudophakic Malignant Glaucoma Using Modified Nd:YAG Laser Treatment Methodology Through Surgical Preset Iridectomy,Ophthalmology and Therapy

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Management of Pseudophakic Malignant Glaucoma Using Modified Nd:YAG Laser Treatment Methodology Through Surgical Preset Iridectomy
Ophthalmology and Therapy ( IF 2.6 ) Pub Date : 2023-11-20 , DOI: 10.1007/s40123-023-00851-5
Mingmin Yang ₁ , Xiaohua Pan ₁ , Zijie Chen ₂ , Xiaoli Shen ₁ , Zhen Yu ₁ , Yufei Tao ₁ , Shan Li ₁ , Xiang Mo ₁ , Xuyang Liu _{2,

3} , Ning Fan ₁

Affiliation

Introduction

The use of the neodymium:yttrium–aluminum-garnet (Nd:YAG) laser to treat malignant glaucoma (MG) has been described in the literature since the 1980s. However, the technique has been reported to have a short-term effect, with a notable relapse rate. In the present study, we report the efficacy and durability of a modified Nd:YAG laser treatment methodology for treatment of pseudophakic or aphakic MG.

Methods

Patients with chronic angle-closure glaucoma and deemed at high risk of developing post-operative MG received prophylactic peripheral iridectomy during their conventional operation beginning in 2017. When the diagnosis of pseudophakic or aphakic MG was confirmed, a thorough Nd:YAG laser capsulo/zonulo-hyaloido-vitreolysis (CZHV) was performed through iridectomy, along with standardized pre- and post-laser medications. This retrospective case series includes 14 eyes of 11 patients with MG who had surgical preset iridectomy and modified Nd:YAG laser CZHV between 2017 and 2022. Outcome measures included resolution and recurrence of MG and incidence of treatment complications.

Results

The mean follow-up was 27.1 ± 15.0 months (range, 12–48). Long-term resolution of MG was obtained in all included eyes at the end of the follow-up. Six eyes (42.9%) achieved long-term resolution with a single Nd:YAG laser intervention. Eight eyes (57.1%) achieved long-term resolution following two to three laser interventions, with two eyes (14.3%) experiencing recurrence. There was no complication during the follow-up. At the final visit, a significant reduction (P = 0.0001) in the mean intraocular pressure (IOP) was observed (13.1 ± 2.8 mmHg) compared to presentation (21.4 ± 6.3 mmHg).

Conclusion

The modified Nd:YAG laser treatment methodology is a minimally invasive option to manage pseudophakic or aphakic MG with sustained effectiveness. Reduced inflammatory reactions due to prophylactic peripheral iridectomy, rapid diagnosis, and timely treatment initiation have all contributed to the favorable outcomes associated with this modified treatment methodology.

中文翻译：

采用改良 Nd:YAG 激光治疗方法通过手术预设虹膜切除术治疗假性晶状体眼恶性青光眼

介绍

自 20 世纪 80 年代以来，已有文献描述了使用钕:钇铝石榴石 (Nd:YAG) 激光治疗恶性青光眼 (MG)。然而，据报道该技术具有短期效果，且复发率显着。在本研究中，我们报告了改良 Nd:YAG 激光治疗方法治疗人工晶状体或无晶状体 MG 的功效和持久性。

方法

患有慢性闭角型青光眼并被认为术后发生 MG 高风险的患者从 2017 年开始在常规手术中接受了预防性周边虹膜切除术。当确诊为人工晶状体或无晶状体 MG 时，需要进行彻底的 Nd:YAG 激光囊/小带切除术。 -玻璃体溶解术（CZHV）是通过虹膜切除术以及标准化的激光治疗前和激光治疗后进行的。该回顾性病例系列包括 2017 年至 2022 年间接受手术预设虹膜切除术和改良 Nd:YAG 激光 CZHV 的 11 名 MG 患者的 14 只眼睛。结果指标包括 MG 的缓解和复发以及治疗并发症的发生率。

结果

平均随访时间为 27.1 ± 15.0 个月（范围：12-48）。在随访结束时，所有纳入的眼睛均获得了 MG 的长期缓解。六只眼睛 (42.9%) 通过单次 Nd:YAG 激光干预实现了长期分辨率。八只眼睛 (57.1%) 经过两到三次激光干预后获得长期缓解，其中两只眼睛 (14.3%) 出现复发。随访期间无并发症发生。在最后一次就诊时，观察到平均眼压 (IOP) 与就诊时 (21.4 ± 6.3 mmHg) 相比显着降低 ( P = 0.0001) (13.1 ± 2.8 mmHg)。