Nonpenetrating filtering surgery and goniopuncture (staged trabeculectomy) for episcleral venous pressure glaucoma

Abstract

Purpose: To report long-term (>5 years) success of non-penetrating filtering surgery in glaucoma due to elevated episcleral venous pressure.

Design: Observational case report.

Methods: A 25-year-old woman developed severe glaucoma due to elevated episcleral venous pressure. Nonpenetrating filtering surgery (opening of the Schlemm canal and resection of corneal stroma overlying the trabecular meshwork and Descemet membrane) was performed with mitomycin. Three months later, the meshwork was perforated ab interno by neodymium:yttrium-aluminum-garnet laser via goniolens (goniopuncture).

Results: There were no complications, and no glaucoma medications were used postoperatively. Intraocular pressure ranged from 10 mm Hg to 18 mm Hg during the first 4 months and thereafter between 6 mm Hg and 12 mm Hg.

Conclusions: Glaucoma due to elevated episcleral venous pressure, an entity associated with significant trabeculectomy risks, can be safely and successfully treated with non-penetrating filtering surgery followed by goniopuncture (staged trabeculectomy).