Preliminary results of CO2 laser-assisted sclerectomy surgery (CLASS) in the treatment of advanced glaucoma in a Chinese population

Abstract

To evaluate the efficacy and safety of CO2 laser-assisted sclerectomy surgery (CLASS) in Chinese patients with advanced glaucoma.Patients with advanced glaucoma who were candidates for glaucoma filtration surgery were included. The intraocular pressure (IOP) and number of antiglaucoma medications were documented before surgery and at all postoperative clinic visits. All intra- and postoperative complications were documented. The primary outcome measures were the changes in IOP and medication use before and after the procedure as well as complications from the procedure. The secondary outcome measure included the CLASS success rate.Twenty patients (23 eyes) underwent CLASS between November 2014 and September 2015. Nineteen eyes had primary open-angle glaucoma, 2 eyes had primary angle-closure glaucoma, and 2 eyes had uveitic glaucoma. One patient was lost to follow-up. The mean age of subjects was 68.1 ± 11.9 years. IOP was significantly reduced at 1 day and 1 week after CLASS. At 6 months, the IOP and number of medications were significantly reduced by 19.0% and 38.2%, respectively (both P < 0.0001). One patient had intraoperative trabeculo-Descemet membrane perforation. Two patients required laser goniopuncture and 2 required needling between 3 and 6 months postoperatively. The overall success rate was 81.8% at 6 months.CLASS achieved a modest IOP reduction in the early postoperative period and was overall a safe procedure for advanced glaucoma.

CO2 laser‐assisted sclerectomy surgery compared with trabeculectomy in primary open‐angle glaucoma and exfoliative glaucoma. A 1‐year follow‐up

“…In contrast to the results published by Yick et al (2016), we believe that CLASS is not a viable therapeutic option for any patient with angle closure glaucoma, uveitic glaucoma or for patients in whom trabeculectomy had already failed due to fibrosis. In contrast to the results published by Yick et al (2016), we believe that CLASS is not a viable therapeutic option for any patient with angle closure glaucoma, uveitic glaucoma or for patients in whom trabeculectomy had already failed due to fibrosis.…”

“…Considering the nature of penetrating and nonpenetrating filtration surgery, it seems unlikely that CLASS can be more potent in IOP lowering than trabeculectomy. In contrast to the results published by Yick et al (2016), we believe that CLASS is not a viable therapeutic option for any patient with angle closure glaucoma, uveitic glaucoma or for patients in whom trabeculectomy had already failed due to fibrosis. It seems unlikely that CLASS, as a nonpenetrating procedure, could be effective in conditions affecting the anatomy of the iridocorneal angle, for example the primary narrow and occludable angles or secondary glaucoma with the presence of peripheral anterior synechia.…”

Scleral Concave Pool Trabeculectomy Combined Phacoemulsification in Primary Open-Angle Glaucoma with Cataract.

“…The CLASS procedure, which showed a similar qualified success rate and reduction in medications compared to conventional trabeculectomy, may be an alternative to trabeculectomy when considering the postoperative complications [11,13,25,26] . During the CLASS procedure, a reservoir is formed by using the CO 2 laser to ablate the scleral tissue [11] .…”

Safety and Efficacy of Scleral Concave Pool Trabeculectomy Combined Phacoemulsification for Eyes with Coexisting Cataract and Primary Open Angle Glaucoma.

“…The CLASS procedure, which showed a similar qualified success rate and reduction in medications compared to conventional trabeculectomy, may be an alternative to trabeculectomy when considering the postoperative complications [8,10,22,23] . During the CLASS procedure, a reservoir is formed by using the CO 2 laser to ablate the scleral tissue [8] .…”