Abstract

SA.16.03

Specific excimer laser for glaucoma surgery ab externo

Takhchidi K. P., Ereskin N. N., Doga A. V., Vartapetov S. K.
S. Fyodorov Eye Microsurgery Complex, Moscow, Russia

Objective: To evaluate the safety and efficacy of a specific 193 nm photopolishing scanning excimer laser for glaucoma surgery.
Methods: 186 eyes of patients aged from 18 to 88 years were operated on between March 2000 and March 2006. The majority of patients had advanced and far-advanced stages of open-angle and narrow-angle glaucoma. Laser iridotomy was performed in patients with narrow-angle glaucoma to enlarge the profile of the anterior chamber angle. A 193 nm photopolishing scanning excimer-laser was used to achieve a deep “non-penetrating laser trabeculo-dissection” under a scleral flap through the Schlemm’s canal and the juxtacanalicular trabecular meshwork. Intraocular pressure (IOP) was recorded preoperatively and postoperatively at 1, 7, 14 days, at 1, 3, 6 months and thereafter every 6 months.
Results: As a result of a micro-invasive intrastromal excimer laser surgery normalization of the IOP was achieved in all cases independently of the disease stage. The mean IOP was 10±2 mm Hg in the early postoperative period. No cases of hemorrhagic complications were observed. In 8% of the cases in patients with far-advanced glaucoma the descemeto-gonio-puncture (DGP) was performed in excimer laser intervention area. It allowed restoring aqueous humor outflow pathways and normalizing the IOP. In the long-term follow-up the mean IOP was 17 mm Hg. In 1 year post-op and more a development of a cystic filtering bleb was observed in 2 eyes. A monotherapy with 0.5% Betoptic solution instillations two times per day was administered in 18 patients with far-advanced glaucoma (10% of cases).
Conclusions: Creation of a specialized excimer laser allows us to develop a safe technology of glaucoma treatment compared to traditional incision surgery.

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