Laser trabeculodissection with a photopolishing scanning excimer laser

Area of Science:

• Ophthalmology
• Surgical Innovation
• Glaucoma Treatment

Background:

• Advanced glaucoma necessitates effective intraocular pressure (IOP) reduction.
• Traditional filtration surgeries like trabeculectomy carry risks of complications.
• Nonpenetrating surgical techniques aim to reduce these risks while maintaining efficacy.

Purpose of the Study:

• To evaluate the safety and efficacy of laser trabeculodissection (LTD) using a scanning excimer laser.
• To assess the laser's ability to achieve deep scleral dissection for filtration without anterior chamber penetration.
• To determine if LTD is a viable alternative to conventional glaucoma surgery.

Main Methods:

• A phase I study involving 8 eyes with advanced glaucoma underwent LTD with a 193 nm scanning excimer laser.
• The procedure involved creating a scleral flap and performing laser dissection through Schlemm's canal and the trabecular meshwork.
• Mitomycin-C was used intraoperatively; no peripheral iridectomy was performed.

Main Results:

• Successful filtration and significant IOP reduction were achieved in all 8 eyes without topical medication.
• No inadvertent anterior chamber penetration, intraoperative hyphema, or postoperative shallowing occurred.
• Postoperative gonioscopy showed an intact inner trabecular meshwork and no new peripheral anterior synechiae.

Conclusions:

• Laser trabeculodissection (LTD) with a 193 nm scanning excimer laser is a promising alternative for glaucoma filtration surgery.
• LTD offers a controlled dissection, potentially avoiding risks associated with full-thickness trabeculectomy.
• Further research is needed to establish the definitive role of LTD in glaucoma management.