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Application of Nd:YAG laser to the anterior vitreous in malignant glaucoma — a systemic review and meta-analysis

  • Glaucoma
  • Published:
Graefe's Archive for Clinical and Experimental Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

The study aims to review the efficacy, safety, and technique of Nd:YAG laser vitreolysis for the management of malignant glaucoma (MG).

Methods

We performed a search of electronic databases for all published studies which included technical specifications of Nd:YAG laser application for MG. Individual patient data was extracted and evaluated in a weighted pooled analysis.

Results

Thirty eyes were reported on from seven studies worldwide. Age of affected patients ranged between 37 and 82 years. Nd:YAG vitreolysis was performed either through an iritodomy (66.7%, 18/27 eyes), transpupillary (18.5%, 5/27 eyes), or through both simultaneously (14.8%, 4/27 eyes). Treatment intensity ranged between 1.0 and 11.00 mJ with 75.9% (22/29 eyes) of treatments being 3.0 mJ or lower. Between 1 and 41 pulses per session were applied. Rates of both anatomical and intraocular pressure resolution were examined. Overall, in a pooled analysis, 77% of eyes demonstrated MG resolution with no further treatment required after Nd:YAG vitreolysis (95% CI: 58.1 to 91.4%). A trend for lower need of additional interventions was seen with transpupillary application (11.1% versus 42.1%). No complications were reported.

Conclusions

Nd:YAG laser vitreolysis is a safe procedure, associated with MG resolution in the majority of reported cases, regardless of treatment intensity. Transpupillary treatment may be associated with lower risk of re-intervention.

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Authors and Affiliations

  1. Ophthalmology Department, Yitzhak Shamir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Margarita Safir, Idan Hecht & Adi Einan-Lifshitz

  2. Ophthalmology Department, Meir Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Margarita Safir, Tal Sharon & Avner Belkin

Authors
  1. Margarita Safir
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  2. Idan Hecht
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  3. Tal Sharon
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  4. Adi Einan-Lifshitz
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Contributions

M. S. collected the data and wrote the manuscript. I. D. performed the statistical analysis and critically revised the manuscript. T. S. and A. E. L. contributed to the discussion and critically revised the manuscript. A. B. contributed to the discussion, critically revised the manuscript, and directed the project.

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Correspondence to Margarita Safir.

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This is a review and meta-analysis article. The Shamir Medical Center Research Ethics Committee has confirmed that no ethical approval is required.

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Safir, M., Hecht, I., Sharon, T. et al. Application of Nd:YAG laser to the anterior vitreous in malignant glaucoma — a systemic review and meta-analysis. Graefes Arch Clin Exp Ophthalmol 260, 2981–2990 (2022). https://doi.org/10.1007/s00417-022-05640-7

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  • DOI: https://doi.org/10.1007/s00417-022-05640-7

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