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Sylvain Roy, Michael Feusier, Delphine Bifrare, Andre Mermoud; Initial Clinical Results Of Co2-laser In Deep Sclerectomy. Invest. Ophthalmol. Vis. Sci. 2011;52(14):2615.
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To evaluate the efficacy and safety profile of a CO2-laser ablation system in non-penetrating glaucoma surgery.
From July 2010 until October 2010 10 eyes from 10 patients suffering from glaucoma have been operated using a CO2-laser ablation system. After a superficial scleral flap was performed a square-shaped deep scleral space was created by CO2-laser ablation. Depth of ablation was limited before reaching the choroidal layer. For the ablation of the inner wall of Schlemm’s canal, an arc-shaped profile was used. Laser treatment was controlled upon oozing of aqueous humour. After sufficient tissue removal was achieved and an efficient drainage was obtained, the scleral flap and the conjunctiva were then sutured. The main outcomes were the mean intraocular pressure (IOP), the mean number of antiglaucoma medication, the number of postoperative complications.
For the 10 eyes the mean age at surgery was 48.2 ± 32.3 years, the mean follow-up was 3.5 ± 1.0 months, the mean preoperative IOP was 20.5 ± 5.3 mmHg, the mean visual acuity was 0.8 ± 0.3 and the mean number of antiglaucoma medication before surgery was 3.2 ± 1.2. At final follow-up visits, the mean IOP went down to 13.2 ± 8.5 mmHg (p<0.005), the mean visual acuity was 0.7 ± 0.3 and the mean number of antiglaucoma medication was reduced to 0.2 ± 0.4 (p<0.005). The filtering bleb was visible on 9 eyes (90%). Overall 5 complications were reported, among which 4 were iris incarceration after goniopuncture and 1 was angle closure glaucoma. Complete success rate (IOP ≤ 18 mmHg without antiglaucoma medication) was 70% and the qualified success rate (IOP ≤ 18 mmHg with and without antiglaucoma medication) was 90%.
A new technique using a CO2-laser ablation system allows precise and easy creation of the scleral space and ablation of Schlemm’s canal. This would render the deep-sclerectomy an easier glaucoma surgery with less complication. From this study the IOP was significantly lowered with less glaucoma medication.
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