Abstract
Purpose: To report the safety and efficiency of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation.Methods: This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions.Results: The mean age of the patient was 42.6 ± 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively.Conclusion: CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.
Highlights
Glaucoma is the leading cause of irreversible blindness worldwide
We described a series of patients with primary open-angle glaucoma (POAG) who underwent CLASS
A total of 23 eyes with POAG that underwent CLASS were recruited in this study including 14 males (60.9%) and 9 females (39.1%)
Summary
Glaucoma is the leading cause of irreversible blindness worldwide. The treatment of glaucoma is focused on reducing IOP through medications, laser, or surgery [2]. Conventional trabeculectomy (Trab) remains to be the gold standard for filtering glaucoma surgery [3]. There are various potential complications, including hypotony, shadow anterior chamber, infection, cataract development, malignant glaucoma, fistula failure, and suprachoroidal hemorrhage, which have direct influence on the success of the surgery [4]. Nonpenetrating deep sclerectomy (NPDS) is an alternative filtering surgery. It was designed to reduce the resistance of aqueous humor outflow by removing the outer wall of Schlemm’s canal and the external part of the adjacent trabecular meshwork tissue, while avoiding penetrating the anterior chamber [6]. Perforation of the trabeculoDescemet membrane (TDM) is the most common intraoperative complication [7]
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