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Carlo Alberto Cutolo, Alessandro Bagnis, Riccardo Scotto, Chiara Bonzano, Carlo Enrico Traverso; Clinical and anatomical evaluation of CO2 laser-assisted sclerectomy. Invest. Ophthalmol. Vis. Sci. 2017;58(8):4989. doi: https://doi.org/.
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To evaluate the clinical and anatomical outcomes of CO2 laser-assisted sclerectomy surgery (CLASS) for the surgical treatment of open-angle glaucoma (OAG).
After the creation of a limbus-based congiunctival flap and the dissection of a partial thickness scleral flap, topical MMC 0.2 mg/ml was applied to the sclera and the conjunctiva for 3 minutes. The CO2 laser with a beam-manipulating system was used to ablate the scleral tissue in the bed of the dissected sclera and to expose the Schlemm's canal area til percolation of aqueous was observed. Clinical outcomes were: intraocular pressure (IOP) change, number of IOP-lowering medicaments change and side effects. Gonioscopy and Automatic 360 degree Gonio-Photography (AGP; Gonioscope NGS-1; Nidek Technologies srl) were used for the evaluation of the anterior chamber angle (ACA).
Twenty-four eyes of 21 consecutive patients were included in this study. With a mean (SD) follow-up of 18 (6.0) months (minimum 12 months), the IOP changed from 25.5 (7.1) mmHg at baseline to 11.4 (3.3) mmHg at the last visit. Mean reduction of IOP was -14.1 mmHg (95% CI, -17.8 to -10.5, P<0.001). The median (IQR) number of IOP-lowering medication decreased from 3 (3 - 3) at baseline to 1 (0 - 1) at the last visit (P<0.001). Visual acuity did not change significantly. In one case, CLASS was converted to trabeculectomy due to intraoperative perforation. During the follow-up, iris adhesion to the filtration area occurred in seven eyes (29%) and was managed with office-based procedures. AGP permitted to evaluate and record the position of the iris in the treated area.
Our results showed that the CLASS procedure with MMC was safe and effective in drastically lowering the IOP and in reducing the requirement for IOP-lowering medications. AGP was useful for the detection of iris adhesion that represented the most frequent, though reversible, complication observed.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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