advertisement

Editors Selection IGR 10-1

Surgical treatment: Laser-assisted dissection of the corneo-scleral flap

Comment by Ike Ahmed on:

20807 CO₂, excimer and erbium:YAG laser in deep sclerectomy, Klink T; Schlunck G; Lieb W et al., Ophthalmologica, 2008; 222: 74-80

Find related abstracts

Klink et al. (414) endeavor to differentiate three laser-assisted dissections of the deep corneo-scleral flap in deep sclerectomy by histological comparison. Using procine eyes, they found it was feasible to ablate the deep corneosclera lamella with perforating using pulsed erbium:YAG, CO₂ and excimer laser (10 eyes/group), and found the thermal the erbium:YAG and excimer provided a smoother surface. Thermal damage was greater with the CO₂ laser (70-100 μm) compared to erbium:YAG (10-30 μm) with no thermal effect seen with the excimer laser. Recognizing that porcine eyes are histologically and different than human eyes, all three of these lasers have been reported in the past and appear to be useful in performing the deep scleral dissection. This comparative and histological study shows the advantage of excimer laser in providing a smoother surface without demonstrable thermal damage. Ablation speed, wound surface area, precision, ease of use, mobility, and costs are other factors in differentiating these lasers that must be considered. Although many surgeons have embraced non-penetrating glaucoma surgery as a safer and nearly or equally efficacious procedure over trabeculectomy, the majority has not due to concerns of efficacy and/or surgical difficulty in learning and performing this procedure. The implications of this study are that laser-assisted nonpenetrating glaucoma surgery appears reliable, overcoming a major challenge in the adoption of this surgery due to technical difficulty in performing the deep scleral dissection manually with metal or diamond blades. However, availability and logistics of using these lasers in the operating room are barriers to widespread adoption of laser-assisted surgery. Another issue not addressed by the authors is whether new non-penetrating procedures, such as canaloplasty, wherein a flexible microcatheter is used to intubate the cut ends of Schlemm's canal at the deep dissection and pass 360° would be possible after ablation.

• ← Previous
• Next →