CO2 Laser-assisted Sclerectomy Surgery for Open-angle Glaucoma

Geffen, Noa; Ton, Yokrat; Muñoz, Gonzalo; Mariotti, Cesare; Assia, Ehud I.

doi:10.17925/eor.2012.06.01.12

Cited by 3 publications

(4 citation statements)

References 24 publications

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“…The rationale behind applying laser energy to create a filtering sclerostomy was that such concentrated energy can improve surgical accuracy and reduce any unnecessary tissue damage. The severity of thermal damage adjacent to the sclerostomy site is believed to be harmful to the long-term success and maintenance of fistula patency [9].The characteristics of the Erbium-doped Yttrium Aluminum Garnet laser (Er:YAG laser) make it a good candidate for the creation of long-standing intraocular openings. While the laser is capable of removing tissue by ablation [10], it is extensively absorbed by water, thus confining the energy to the desired area and tissue, with minimal thermal damage.…”

Section: Discussionmentioning

confidence: 99%

Er:YAG laser-assisted filtration surgery: initial results in rabbits

et al. 2021

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Background Glaucoma is a leading cause of global blindness, especially preventable blindness. The increased prevalence of glaucoma has led to a growing demand for newer, safer, more rapid, and simpler treatments for the reduction of intraocular pressure (IOP). In this study, we evaluated the safety and feasibility of performing filtration glaucoma surgery with an Ab-Interno Er:YAG laser in rabbits. Methods Nine New Zealand White rabbits age 16 weeks were studied. After subconjunctival injection of mitomycin C (MMC), a novel Ab-Interno Er:YAG laser probe was inserted into the anterior chamber (AC) through a clear corneal 1 mm paracentesis and directed at the trabecular meshwork adjacent to the MMC injection area. A pulsed laser beam was applied to create a patent sclerostomy connecting the AC to the subconjuctival space, resulting in a filtering bleb. The laser system used was the Er:YAG laser system - LAS25-FCU, (Pantec Biosolutions AG, Liechtenstein). Parameters used: Wave lengh: 2940 nm, Pulse length: 100–400 μsec,frequency: 250 Hz. Average laser power in accordance to the fiber tip diameter: 0.85 W(range 0.8–0.92 W). Complete ocular exams, including IOP measurements, were performed on 1, 7, 14, and 23 days postoperatively. Three rabbits were sacrificed on days 1, 14, and 23, and histological examinations were performed on all nine eyes. Results All procedures resulted in a functional medium-large superior bleb without significant complications. The bleb was sustained in all rabbits by day 14 and in one of the three rabbits that reached the last follow-up at 23 days. No cases of postoperative hypotony were observed. There was a transient significant reduction in mean IOP on postoperative days 5 and 7 (P = 0.028). Histopathological analysis revealed a patent full-thickness scleral tunnel with only a minor degree of surrounding coagulation necrosis. Conclusions The Ab-Interno laser sclerostomy procedure is potentially safe and effective based on initial experience in an in-vivo rabbit animal model.

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Section: Discussionmentioning

confidence: 99%

Er:YAG laser-assisted filtration surgery: initial results in rabbits

et al. 2021

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“…The efficacy of CLASS surgery in lowering IOP is confirmed by numerous studies. 6,7,[9][10][11][12] NPDS is the surgical basis for CLASS surgery, and it was proved by Gesser to efficiently stabilize visual field over an 8-year period. 3 Greifner compared the efficacy of NPDS and CLASS in terms of IOP-reduction, and reported total success rate and qualified success rate of CLASS be better than that of NPDS.…”

Section: Discussionmentioning

confidence: 99%

“…5 Publications about the human application of CO2 laser-assisted sclerectomy surgery (CLASS) see back only a few years now. 6,7 Several authors report on the efficacy of the surgery. According to their results, CLASS surgery reduces IOP very efficiently, at the same time, it also has a high postoperative total success and qualified success rate.…”

Section: Introductionmentioning

confidence: 99%

“…According to their results, CLASS surgery reduces IOP very efficiently, at the same time, it also has a high postoperative total success and qualified success rate. [6][7][8][9] Geffen et al report about significant and permanent IOP reduction even after a 3-year follow-up time. 10 In the latest study on the issue by Jankowska-Szmul, the efficacy of CLASS surgery and trabeculectomy was compared.…”

Section: Introductionmentioning

confidence: 99%

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<p>Retinal Nerve Fibre Layer Thickness Change After CO2 Laser-Assisted Deep Sclerectomy Surgery</p>

Sohajda¹,

Széll²,

Revák³

et al. 2020

OPTH

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The goal of our study was to investigate changes in intraocular pressure (IOP), best-corrected visual acuity (BCVA), and retinal nerve fibre layer thickness (RNFLT) after CO2 laser-assisted deep sclerectomy (CLASS). Methods: We carried out uncomplicated CLASS surgeries and a 12-month follow-up on 22 open-angle glaucomatous (OAG) eyes of 22 patients. IOP, BCVA, and RNFLT with spectraldomain optical coherence tomography (SD OCT) were recorded before and 1, 3, 6, 12 months after surgery. Results: Mean age of patients was 68.1 years. IOP decreased from preoperative 28.45±5.99 SD mmHg (mean±standard deviation) to 15.09±2.40 mmHg (p=0.00039) at 12 months after surgery. BCVA-change from preoperative 0.34±0.38 SD (LogMAR) to 0.37±0.41 SD (LogMAR) was not significant (p=0.2456). RNFLT-change from preoperative 60.50 ±18.15µm to 59.63±17.52 µm at 12 months postoperatively was not significant (p=0.056). Qualified success rate of CLASS surgery was 72.7%, whereas complete success rate was 64% at 1 year postoperatively. Conclusion: Successful CLASS surgery efficiently reduced IOP. At postoperative 12 months, RNFLT and BCVA were not reduced significantly. There was no significant glaucomatous progression after surgery encountered in respect of investigated parameters.

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CO₂-lézerrel végzett mélysclerectomiával szerzett tapasztalatok

Sohajda¹,

Káldi²,

Facskó

2017

Orvosi Hetilap

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Bevezetés: A CO 2 -lézeres mélysclerectomia (CLASS) a nyitott zugú glaucomás betegek sebészi kezelésében alkalmazható. Célkitűzés: A CLASS-műtéttel szerzett tapasztalataink ismertetése. Módszer: 21 CLASS-műtétet végeztünk OT-134-IOPtiMate (IOPtima Ltd, Ramat-Gan, Izrael) készülékkel. A betegeket a posztoperatív első napon, majd 1, 3, 6, 9 és 12 hónap múlva kontrolláltuk. Retrospektíven értékeltük a szemnyomás, antiglaucomás terápia és a visus alakulását, az intra-és posztoperatív szövődményeket. Eredmények: Az átlagéletkor 65,6 év volt. A teljes siker (szemcsepp nélkül elért célszemnyomás) a hatodik hónapra (18 beteg) 61,1%, míg a 12. hónapnál (10 beteg) 50% volt. A minősített siker (szemcseppel elért célszemnyomás) 72,2% és 70%, a preoperatív átlagos 29,2 ± 9,4 Hgmm-es szemnyomás rendre 17,7 ± 4,9 Hgmm és 17,3 ± 4,3 Hgmm volt. Jelentősen csökkent az antiglaucomás cseppek átlagos száma: 2,90 ± 0,83-ról 2,05 ± 1,46 értékre. Egy makroperforáción túl a műtét eredményességét befolyásoló egyéb lényeges szövődmény nem volt. Következtetések: CLASS-műtéttel tapasztalataink szerint hatékonyan csökkent-hető a szemnyomás nyitott zugú glaucomában. Orv Hetil. 2017; 158(18): 701-705. Kulcsszavak: CLASS, nyitott zugú glaucoma Experiences with CO 2 laser-assisted sclerectomy surgeryIntroduction: CO 2 laser-assisted sclerectomy surgery (CLASS) can be used for the surgical treatment of open-angle glaucoma. Aim: To introduce our results with CLASS. Method: We performed 21 CLASS operations using OT-134-IOPtiMate (IOPtima Ltd, Ramat-Gan, Israel). Patients were examined on the 1st day, and in the 1st, 3rd, 6th, 9th and 12th months postoperatively. We evaluated intraocular pressure (IOP), antiglaucomatous medication-use, visual acuity, complications. Results: Mean age was 65.6 yrs. Complete success (no hypotensive medication required to target IOP) was achieved in 61.1% (18 patients) at 6 months, whereas in 50% (10 patients) at 12 months. Qualified success (hypotensive medication required to target IOP) was achieved in 72.2% and in 70%, preoperative mean IOP was 29.2 ± 9.4 Hgmm, which falled to 17.7 ± 4.9 Hgmm and 17.3 ± 4.3 Hgmm, respectively. Antiglaucomatous medication use falled significantly from 2.90 ± 0.83 to 2.05 ± 1.46. Apart from 1 macroperforation, no serious complication occurred. Conclusions: With CLASS it is possible to effectively lower intraocular pressure in open-angle glaucoma.

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CO2 Laser-assisted Sclerectomy Surgery for Open-angle Glaucoma

Cited by 3 publications

References 24 publications

Er:YAG laser-assisted filtration surgery: initial results in rabbits

Er:YAG laser-assisted filtration surgery: initial results in rabbits

<p>Retinal Nerve Fibre Layer Thickness Change After CO2 Laser-Assisted Deep Sclerectomy Surgery</p>

CO₂-lézerrel végzett mélysclerectomiával szerzett tapasztalatok

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CO2 Laser-assisted Sclerectomy Surgery for Open-angle Glaucoma

Cited by 3 publications

References 24 publications

Er:YAG laser-assisted filtration surgery: initial results in rabbits

Er:YAG laser-assisted filtration surgery: initial results in rabbits

<p>Retinal Nerve Fibre Layer Thickness Change After CO2 Laser-Assisted Deep Sclerectomy Surgery</p>

CO2-lézerrel végzett mélysclerectomiával szerzett tapasztalatok

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CO₂-lézerrel végzett mélysclerectomiával szerzett tapasztalatok