Abstract
A historical recall and an attempt to simplify the numerous terms used to designate laser treatments for primary open-angle glaucoma (POAG) are presented. There are two main types of laser treatment for POAG involving two entirely different procedures. The first one, contemporary with the beginning of laser photocoagulation, imitates the action of the scalpel, namely goniotomy ab interno or trabeculotomy ab externo. The goal of this early procedure was to produce a through and through trabecular hole but instead of the cutting edge of the knife, it uses the explosive effect of the laser. This procedure has been given numerous names. Among the most frequent ones, we find: ‘laser trabeculopuncture’, ‘laseropuncture’, ‘goniopuncture’, ‘laser trabeculectomy’, ‘laser trabeculotomy’, ‘laser trabeculopexy’. We prefer to gather them under an explicit generic term: ‘laser trabeculoperforation’. The results of this procedure have been very disappointing until now, particularly with conventional lasers, e.g. continuous-wave argon laser, owing to the predominance of their thermal effect over their explosive effect and also to the great scarring property of the trabecular meshwork. In the second type of glaucoma laser treatment, instead of trying to make a patent hole in the trabecular meshwork, the surgeon seeks to reshape the inner trabecular surface by means of argon laser microscars in order to produce a reversal of the trabecular collapse, which is now considered to be one of the major etiologies of POAG. Since our first attempts in 1981, we have chosen to describe this procedure with the term: ‘laser trabeculoretraction’ because this presents a triple advantage: it accurately localizes the site to be photocoagulated, i.e. the trabecular meshwork; it illustrates clearly the theoretical mechanism of action which is essentially mechanical and backed up by an increasing number of arguments; lastly, it contrasts without ambiguity with the early procedure which seeks to produce a completely patent through and through trabecular hole, i.e. laser trabeculoperforation. In the English literature, the term laser ‘trabeculoplasty’, more widely used to describe the technique of Wise seems less precise to us. Furthermore, it can lead to confusion with trabeculoperforation procedure. There is also a difference in the efficacy of these procedures: laser trabeculoretraction has been considered ‘a real quiet revolution in the treatment of POAG’.