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M Ito; Ocular Integrity and Histology After Scleral Blation by the Er: YAG Laser . Invest. Ophthalmol. Vis. Sci. 2002;43(13):4118.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To establish the risk of ocular rupture after proposed surgical reversal of presbyopia by the Er:YAG laser (HOYA Continuum, Tokyo, Japan) and by anterior ciliary sclerotomy (ACS). Methods: The surgery was performed on 45 pig eyes. Each of the 15 eyes were placed into one of two study groups and another 15 eyes were used as controls. One group had the Er:YAG scleral incisions at a pulse repetition rate of 10 Hz with energy of 40 mJ/pulse. Eight radial incisions, 2 parallel cuts each at 4 quadrants, 2 mm apart, 4 mm long, and starting 2 mm away from the limbus, were made. The other group underwent scleral incisions with the use of a diamond knife, preset at 350 µm, in the same incision design as the first group, which simulated ACS. To assess the risk of ocular rupture, a trauma delivery device was constructed. The device was designed to deliver energy from a 3-Kg steel weight that was released from a measured height to the pig's eye. The eyes were subjected to trauma immediately after their individual procedures, and the trauma energy was calculated. All eyes were inspected visually after each trial for sites of rupture, and the trials were continued until the rupture occurred. In the separate group of eyes after laser surgery, light microscopy was performed. Results: The mean rupture force for each study group was 12 3.5 J (the Er:YAG laser group), 16 5.2 J (ACS group), and 26 2.2 J (control), respectively. The Er:YAG laser and ACS eyes ruptured at significantly lower forces (the Er:YAG, P < 0.001; ACS, P < 0.001) than did the control eyes. Comparison of the Er:YAG laser and ACS showed no statistically significant difference (P = 0.052) in rupture force. All eyes with the laser surgery ruptured at the incision site, while 40% of the ACS eyes ruptured at a remote site from the incisions. Histologic analysis showed collateral thermal change at the laser incision site, but the adjacent stromal tissue seemed to remain unaffected. Conclusion: Any patients considering the Er:YAG laser scleral incision or ACS should be counseled about the attendant potential risk after ocular trauma.
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