Evaluating the safety and efficacy of phacoemulsification combined with CO2 laser-assisted sclerectomy surgery (CLASS)

Session Details

Session Title: Glaucoma II

Session Date/Time: Monday 15/09/2014 | 08:00-10:30

Paper Time: 08:25

Venue: Boulevard F (Level 1)

First Author: : R.Venkatesh INDIA

Co Author(s): :    S. Sengupta              

Abstract Details

Purpose:

To evaluate the safety and efficacy of phacoemulsification combined with CO2 Laser Assisted sclerectomy Surgery (CLASS) in patients with open-angle glaucoma.

Setting:

Aravind Eye Hospital, Pondicherry.

Methods:

A prospective, single-arm, non-randomized clinical trial. About 17 patients with Primary Open Angle Glaucoma (POAG) or Pseudoexfoliative Glaucoma (PEXG), baseline IOP >21 mmHg with or without anti-glaucoma medications were included. The surgery was performed through twin sites, initially a half- thickness rectangular scleral flap was created in the superior scleral area following which a phacoemulsification with IOL implantation was performed through the temporal clear corneal tunnel. After completion of cataract surgery a CO2 laser (“IOPtiMate”; IOPtima Ltd, Israel) was used to achieve deep scleral ablation and the end point of un-roofing of Schlemm’s Canal confirmed by fluid percolation was performed in all patients. Intraocular pressure (IOP) was measured at baseline and during follow-up visits. Complete and Qualified success rates were defined as 5≤IOP≤18 mm Hg without or with one medication, respectively.

Results:

The pre-operative IOP of 29.0 ± 12.3 mm Hg (mean ± SD) reduced to 14.6 ± 4.3 mm Hg at 12 months (n=17, p=0.0001, paired t test) and 13.0 ± 2.2 mm Hg at 24 months postoperatively (n=4, p=0.08). The Complete Success rate after 12 months was 70.5%, whereas Qualified Success was seen in another 17.6 %. Mitomycin C was used in 88% of the subjects.

Conclusions:

This study demonstrates that phacoemulsification combined with CLASS is a simple, safe, and effective technique for treating patients with open-angle glaucoma. Using a CO2 laser allows precise and easy ablation of the deep scleral space and delicate dissection of Schlemm’s canal and Descemet’s membrane.

Financial Interest:

NONE