Radial Optic Neurotomy and Lamina Cribosa Puncture: A New Treatment to Decrease IOP?

Abstract

Abstract: : Purpose: To assess if radial optic neurotomy (RON) and lamina cribosa puncture (LCP) decrease intraocular pressure (IOP). Methods: Preoperative and postoperative retrospective measurement of IOP in eight eyes that underwent RON to treat ischemic central retinal vein occlusion with 6 month follow-up. One patient with one eye end stage glaucoma (no light perception), after signed informed consent aprooved by the IRB, underwent vitrectomy, posterior hyaloid removal, and LCP (as performed by D'Amico, Retina Congress 2002) using a 360 microns sapphire tip. Preoperative and postoperative IOP was compared. Results: In RON eyes, the mean preoperative IOP was 16.33 mmHg (range 12-21) and after 6 months follow-up, the mean postoperative IOP was 11 mmHg (range 8-12), showing an important IOP reduction (without glaucoma medications). The eye with LCP had a preoperative IOP of 44 mmHg (with three topical IOP lowering medications), and a postoperative IOP of 10 mmHg without treatment (follow-up, 10 weeks). Conclusions: RON and LCP were associated with an important decrease in IOP. Analysis of this phenomena warrants further investigation. The possibility of opening the lamina cribosa fibers with minimal nerve fiber layer disruption, might be a promising procedure to lower IOP in patients with difficult control glaucoma.

Keywords: vitreoretinal surgery • intraocular pressure • retina