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1 General aspects (0)   1.1 Epidemiology (2)   1.2 Population genetics (14)   1.3 Pathogenesis (13)   1.4 Quality of life (1)   1.5 Glaucomas as cause of blindness (2)   1.6 Prevention and screening (2) 2 Anatomical structures in glaucoma (0)   2.1 Conjunctiva (1)   2.2 Cornea (1)   2.3 Sclera (1)   2.4 Anterior chamber angle (0)   2.5 Meshwork (8)     2.5.1 Trabecular meshwork (0)     2.5.2 Schlemms canal (0)     2.5.3 Scleral outlet channels (0)   2.6 Aqueous humor dynamics (3)     2.6.1 Production (0)     2.6.2 Outflow (0)       2.6.2.1 Trabecular meshwork (0)       2.6.2.2 Uveoscleral (0)     2.6.3 Compostion (0)   2.7 Episcleral veins and venous pressure (0)   2.8 Iris (0)   2.9 Ciliary body (4)   2.10 Lens (0)   2.11 Vitreous body (0)   2.12 Choroid, peripapillary choroid, peripapillary atrophy (2)   2.13 Retina and retinal nerve fibre layer (15)   2.14 Optic disc (18)   2.15 Optic nerve (0)   2.16 Chiasma and retrochiasmal central nervous system (1)   2.17 Stem cells (0)   2.20 Other (1) 3 Laboratory methods (2)   3.1 Microscopy (1)   3.2 Electron microscopy (0)   3.3 Immunohistochemistry (5)   3.4 Molecular genetics (1)     3.4.1 Linkage studies (0)     3.4.2 Gene studies (0)   3.5 Molecular biology incl. 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    9.4.1 Steroid-induced glaucoma (1)     9.4.2 Glaucomas associated with disorders of the cornea, conjunctiva, sclera (0)       9.4.2.1 Iridocorneal endothelial syndrome (ICE, incl. irisatrophy) (0)       9.4.2.2 Posterior polymorphous dystrophy (0)       9.4.2.3 Fuchs' endothelial dystrophy (0)       9.4.2.5 Other (0)     9.4.3 Glaucomas associated with disorders of the iris and ciliary body (0)       9.4.3.1 Pigmentary glaucoma (0)       9.4.3.5 Other (1)     9.4.4 Glaucomas associated with disorders of the lens (0)       9.4.4.1 Exfoliation syndrome (6)       9.4.4.2 Glaucomas associated with cataracts (0)       9.4.4.3 Glaucomas associated with lens dislocation (0)       9.4.4.5 Other (1)     9.4.5 Glaucomas associated with disorders of the retina, choroid and vitreous (1)       9.4.5.1 Neovascular glaucoma (3)       9.4.5.5 Other (0)     9.4.6 Glaucomas associated with inflammation, uveitis (3)     9.4.7 Glaucomas associated with ocular trauma (2)     9.4.8 Glaucomas associated with intraocular tumors (0)     9.4.9 Glaucomas associated with elevated episcleral venous pressure (0)       9.4.10 Glaucomas associated with hemorrhage (0)     9.4.11 Glaucomas following intraocular surgery (0)       9.4.11.1 Ciliary block (malignant) glaucoma (0)       9.4.11.2 Glaucomas in aphakia and pseudophakia (1)       9.4.11.3 Epithelial, fibrous, and endothelial proliferation (0)       9.4.11.4 Glaucomas associated with corneal surgery (3)       9.4.11.5 Glaucomas associated with vitreoretinal surgery (0)     9.4.15 Glaucoma in relation to systemic disease (3)     9.4.20 Other (0) 10 Differential diagnosis e.g. anterior and posterior ischemic optic neuropathy (3) 11 Medical treatment (0)   11.1 General management, indication (7)   11.2 Cholinergic drugs (1)   11.3 Adrenergic drugs (0)     11.3.1 Epinephrine (0)     11.3.2 Thymoxamine, dapiprazole (0)     11.3.3 Apraclonidine, brimonidine (10)     11.3.4 Betablocker (15)     11.3.5 Other (0)   11.4 Prostaglandins (23)   11.5 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Without tube implant (5)     12.8.2 With tube implant or other drainage devices (5)     12.8.3 Non-perforating (18)     12.8.4 Using laser (1)     12.8.5 Other (1)     12.8.10 Woundhealing antifibrosis (12)     12.8.11 Complications, endophthalmitis (10)   12.9 Trabeculotomy, goniotomy (1)   12.10 Cyclodestruction (5)   12.11 Cyclodialysis (0)   12.12 Cataract extraction (0)     12.12.1 Intracapsular (0)     12.12.2 Extracapsular (0)     12.12.3 Phacoemulsification (10)   12.14 Combined cataract extraction and glaucoma surgery (0)     12.14.1 Intracapsular (0)     12.14.2 Extracapsular (0)     12.14.3 Phacoemulsification (3)   12.15 Capsulotomy (1)   12.16 Vitrectomy (0)   12.17 Anesthesia (5)   12.20 Other (2) 13 Therapeutic prognosis and outcome (0)   13.1 Prognostic factors (0)   13.2 Outcome (0)     13.2.1 IOP (0)     13.2.2 Visual field (0)       13.2.2.1 Progression (0)       13.2.2.2 Improvement (0)     13.2.3 Other (0) 14 Costing studies; pharmacoeconomics (2) 15 Miscellaneous (3)

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Abstract #3662 Published in IGR 4-2

Laser-assisted deep sclerectomy

Verges C; Llevat E; Bardavio J
Journal of Cataract and Refractive Surgery 2002; 28: 758-765

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PURPOSE: To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG). METHODS: This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any previous treatment for glaucoma. Eight had received one medication; 14, two medications; and seven, three medications. The mean duration of treatment was 18.3 ± 9.4 months (SD). After mitomycin-C 0.02% was administered for two minutes, a superficial 4.0 x 4.0 mm scleral flap was created and a deep 3.0 x 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at one, three, and seven days, two, three, and four weeks, and then every three months up to 15 months. RESULTS: The mean preoperative intraocular pressure (IOP) was 28.3 ± 6.1 mmHg. The mean postoperative IOP was 14.1 ± 3.5 mmHg at 24 hours, 16.3 ± 4.2 mmHg at three months, and 15.3 ± 2.7 mmHg at 15 months (p < 0.001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than two medications and a treatment period longer than one year preoperatively (p < 0.006). The presence of a filtering bleb was associated with a longer period of decreased IOP (p < 0.007). The success rate (IOP ≤ 18 mmHg without medication) was 93.47% at one month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost two lines of visual acuity because of cystoid macular edema. CONCLUSIONS: Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.

Dr. C. Verges, Department of Ophthalmology, Institut Universitari Dexeus, Barcelona, Spain. cverges@cverges.com

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Classification:

12.8.3 Non-perforating (Part of: 12 Surgical treatment > 12.8 Filtering surgery)

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