Experimental Studies on Nonpenetrating Filtration Surgery Using the CO2 Laser

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2006 Oct 24

PMID 17058094

Citations 11

Authors

Ehud I Assia

Yigal Rotenstreich

Irina S Barequet

David J Apple

Mordechai Rosner

Michael Belkin

Affiliations

Soon will be listed here.

Abstract

Background: This study evaluated the use of a CO2 laser for performing deep sclerectomy in nonpenetrating filtration surgery.

Methods: Three experimental models were performed: enucleated sheep and cow eyes (n=18) to determine optimal irradiation parameters, live rabbit eyes (n=20) to test feasibility, and cadaver eyes (40 procedures in 20 eyes) to study effects in human eyes tissue. After a half-thickness scleral flap was created, deep sclerectomy was performed by CO2 laser applications on the scleral bed down to the trabeculo-Descemet's membrane.

Results: Fluid percolation was repeatedly achieved without penetration in sheep and cow eyes using scanned laser energy of 5-10 W at a pulse duration of 200 micros and a working distance of 35 cm. In live rabbits, deep sclerectomy was achieved without perforation in 19/20 eyes. Intraocular pressure was significantly decreased on the first postoperative day (10.3+/-5.1 mmHg lower, on average, than in the nonoperated fellow eye; P<0.001), and this persisted for 21 days. Operations on all cadaver eyes resulted in effective fluid percolation. Penetration of the scleral wall occurred in five cases only after repeated laser applications with high energy. Histologically, a thin sclerocorneal intact wall was demonstrated at the sclerectomy bed. Collateral tissue damage did not extend beyond 100 microm, and adjacent structures remained unharmed.

Conclusions: CO2 laser-assisted deep sclerectomy is a feasible and apparently safe procedure.

Citing Articles

An overview and update of CO laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review).

Huang C, Shen X, Chen M, Wang K Exp Ther Med. 2023; 25(6):270.

PMID: 37206549 PMC: 10189749. DOI: 10.3892/etm.2023.11969.

Clinical application of the CO laser in Ab externo Schlemm's canal surgery.

Zhang L, Yao Y, Lin Q, Li Y, Zhang J Front Med (Lausanne). 2022; 9:974056.

PMID: 36052326 PMC: 9424721. DOI: 10.3389/fmed.2022.974056.

Management of Intraocular Pressure Elevation After CO Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma.

Chen M, Gu Y, Yang Y, Zhang Q, Liu X, Wang K Front Med (Lausanne). 2022; 8:806734.

PMID: 35004782 PMC: 8740123. DOI: 10.3389/fmed.2021.806734.

Comparison of Long-Term Effects After Modified CO Laser-Assisted Deep Sclerectomy and Conventional Trabeculectomy in Chinese Primary Open-Angle Glaucoma.

Zhang Y, Mao J, Zhou Q, Li L, Zhang S, Bian A Ophthalmol Ther. 2021; 11(1):321-331.

PMID: 34862960 PMC: 8770782. DOI: 10.1007/s40123-021-00413-7.

Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification.

Raja S, Ponnat A, Balagiri K, Pallamparthy S Indian J Ophthalmol. 2021; 69(10):2741-2745.

PMID: 34571626 PMC: 8597511. DOI: 10.4103/ijo.IJO_3310_20.

References

Iwach A, Hoskins Jr H, Drake M, Dickens C . Subconjunctival THC:YAG ("holmium") laser thermal sclerostomy ab externo. A one-year report. Ophthalmology. 1993; 100(3):356-65; discussion 365-6. View

Khaw P, Siriwardena D . "New" surgical treatments for glaucoma. Br J Ophthalmol. 1999; 83(1):1-2. PMC: 1722793. DOI: 10.1136/bjo.83.1.1. View

Drake M . Complications of glaucoma filtration surgery. Int Ophthalmol Clin. 1992; 32(4):115-30. DOI: 10.1097/00004397-199223000-00009. View

Iwach A, Hoskins Jr H, Mora J, Dickens C, Drake M, Gaffney M . Update on the subconjunctival THC:YAG (holmium) laser sclerostomy Ab externo clinical trial: a 4-year report. Ophthalmic Surg Lasers. 1996; 27(10):823-31. View

Wishart P, Wishart M, Porooshani H . Viscocanalostomy and deep sclerectomy for the surgical treatment of glaucoma: a longterm follow-up. Acta Ophthalmol Scand. 2003; 81(4):343-8. DOI: 10.1034/j.1600-0420.2003.00103.x. View

Guven D, Karakurt A, Ziraman I, Hasiripi H . Non-penetrating deep sclerectomy in unilateral open-angle glaucoma secondary to idiopathic dilated episcleral veins. Eur J Ophthalmol. 2002; 12(1):66-8. DOI: 10.1177/112067210201200113. View

Wesley R, Bond J . Carbon dioxide laser in ophthalmic plastic and orbital surgery. Ophthalmic Surg. 1985; 16(10):631-3. View

Sourdille P . Nonpenetrating trabecular surgery: it's worth the change. J Cataract Refract Surg. 1999; 25(3):298-300. DOI: 10.1016/s0886-3350(99)80066-2. View

Dahan E, Drusedau M . Nonpenetrating filtration surgery for glaucoma: control by surgery only. J Cataract Refract Surg. 2000; 26(5):695-701. DOI: 10.1016/s0886-3350(00)00366-7. View

10.

Detry-Morel M . Non penetrating deep sclerectomy (NPDS) with SKGEL implant and/or 5-fluorouracile (5-FU). Bull Soc Belge Ophtalmol. 2001; (280):23-32. View

11.

Verges C, Llevat E, Bardavio J . Laser-assisted deep sclerectomy. J Cataract Refract Surg. 2002; 28(5):758-65. DOI: 10.1016/s0886-3350(01)01257-3. View

12.

LESPERANCE Jr F, Mittl R, James Jr W . Carbon dioxide laser trabeculostomy for the treatment of neovascular glaucoma. Ophthalmology. 1983; 90(7):821-9. DOI: 10.1016/s0161-6420(83)34497-3. View

13.

Argento C, Sanseau A, Badoza D, Casiraghi J . Deep sclerectomy with a collagen implant using the excimer laser. J Cataract Refract Surg. 2001; 27(4):504-6. DOI: 10.1016/s0886-3350(00)00609-x. View

14.

Beckman H, FULLER T . Carbon dioxide laser scleral dissection and filtering procedure for glaucoma. Am J Ophthalmol. 1979; 88(1):73-7. DOI: 10.1016/0002-9394(79)90758-x. View

15.

Brooks A, Samuel M, Carroll N, Downie N, Taylor H . Excimer laser filtration surgery. Am J Ophthalmol. 1995; 119(1):40-7. DOI: 10.1016/s0002-9394(14)73811-5. View

16.

Schuman J, Chang W, Wang N, de Kater A, Allingham R . Excimer laser effects on outflow facility and outflow pathway morphology. Invest Ophthalmol Vis Sci. 1999; 40(8):1676-80. View

17.

Klink T, Lieb W, Grehn F . Erbium-YAG laser-assisted preparation of deep sclerectomy. Graefes Arch Clin Exp Ophthalmol. 2000; 238(9):792-6. DOI: 10.1007/s004170000169. View

18.

Mermoud A, Schnyder C, Sickenberg M, Chiou A, Hediguer S, Faggioni R . Comparison of deep sclerectomy with collagen implant and trabeculectomy in open-angle glaucoma. J Cataract Refract Surg. 1999; 25(3):323-31. DOI: 10.1016/s0886-3350(99)80079-0. View

19.

Sourdille P, Santiago P, Villain F, Yamamichi M, Tahi H, Parel J . Reticulated hyaluronic acid implant in nonperforating trabecular surgery. J Cataract Refract Surg. 1999; 25(3):332-9. DOI: 10.1016/s0886-3350(99)80080-7. View

20.

Nouri-Mahdavi K, BRIGATTI L, Weitzman M, Caprioli J . Outcomes of trabeculectomy for primary open-angle glaucoma. Ophthalmology. 1995; 102(12):1760-9. DOI: 10.1016/s0161-6420(95)30796-8. View