Four-year experience with argon laser trabecular surgery in uncontrolled open-angle glaucoma.

Eighty-two phakic eyes with uncontrolled open-angle glaucoma underwent 360 degrees argon laser trabecular surgery. There was a 77% success rate with a mean follow-up of 24 months in the successful group. A glaucoma diagnosis of exfoliation syndrome or open-angle glaucoma, an age greater than 60, and a baseline pressure of less than 26 mmHg were each associated with an increased success rate. The mean pressure change in the treated eye reached its maximum at two months, with a 9.7 mmHg decrease, and the pressure lowering effect slowly decreased with time to a 5.9 mmHg decrease at 42 months. It increased again at 48 months. Failure occurred within two years in 18 of the 19 eyes, and the remaining eye failed at 36 months. Long-term tonographic data shows significant improvement in outflow through 30 months. Argon laser trabecular surgery continues to enjoy an excellent risk-vs-benefit ratio, but its use should still be limited to patients with uncontrolled open-angle glaucoma on maximum medical therapy who are surgical candidates.