Clinical and anatomical evaluation of CO2 laser-assisted sclerectomy

Session Details

Session Title: Glaucoma

Session Date/Time: Monday 09/10/2017 | 08:00-10:30

Paper Time: 08:18

Venue: Room 4.1

First Author: : C.Cutolo ITALY

Co Author(s): :    A. Bagnis   R. Scotto   C. Traverso              

Abstract Details

Purpose:

To evaluate the clinical and anatomical outcomes of CO2 laser-assisted sclerectomy surgery (CLASS) for the surgical treatment of open-angle glaucoma.

Setting:

Clinica Oculistica, Di.N.O.G.M.I. University of Genoa and IRCCS Azienda Ospedaliera Universitaria San Martino IST, Genova, Italy.

Methods:

After the creation of a limbus-based conjunctival 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 till percolation of aqueous was observed. Clinical outcomes were: intraocular pressure (IOP) change, number of IOP-lowering medicaments change and side effects. Automatic Gonio-Photography (AGP) was used for the evaluation of the anterior chamber angle.

Results:

Twenty-four eyes of 21 consecutive patients were included. With a mean (SD) follow-up of 18 (6.0) months (minimum 12 months), the IOP changed from 25.5 (7.1) 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). In one case, CLASS was converted to trabeculectomy. Iris adhesion to the filtration area occurred in seven eyes (29%) and was managed with office-based procedures.

Conclusions:

Our results showed that 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.

Financial Disclosure:

travel has been funded, fully or partially, by a company producing, developing or supplying the product or procedure presented