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Published on: September 20, 2024
CO2, excimer and erbium:YAG laser in deep sclerectomy
Thomas Klink1, Gunther Schlunck, Wolfgang Lieb
1Department of Ophthalmology, Julius Maximilian University, Wurzburg, Germany. klink_t@klinik.uni-wuerzburg.de
Summary
This study compared CO2, excimer, and erbium:YAG lasers for deep sclerectomy, a glaucoma surgery. The excimer laser demonstrated superior tissue dissection with smoother surfaces and no thermal damage, making it a promising tool for this procedure.
Area of Science:
- Ophthalmology
- Surgical Technology
- Glaucoma Surgery
Background:
- Deep sclerectomy is a challenging glaucoma surgical technique due to difficult tissue dissection.
- Current methods for deep lamellar dissection have variable success rates.
- Novel laser technologies may offer improved precision and outcomes.
Purpose of the Study:
- To compare the efficacy of CO2, excimer, and erbium:YAG lasers in dissecting the deep corneoscleral lamella.
- To evaluate the histological and surface characteristics of deep lamellar dissection using different lasers.
- To assess the potential of laser-assisted deep sclerectomy for glaucoma treatment.
Main Methods:
- Surgical dissection of a superficial lamellar scleral flap in porcine eyes.
- Removal of the deep lamella using pulsed erbium:YAG, CO2, or excimer lasers (10 eyes per group).
- Histological analysis and scanning electron microscopy (SEM) of all specimens.
Main Results:
- All tested lasers (CO2, excimer, erbium:YAG) could ablate the deep corneoscleral lamella without anterior chamber perforation.
- CO2 and excimer lasers produced smoother tissue surfaces compared to the erbium:YAG laser.
- Excimer laser treatment resulted in no thermal damage, while erbium:YAG and CO2 lasers caused thermal damage zones of 10-30 µm and 70-100 µm, respectively.
Conclusions:
- Excimer, erbium:YAG, and CO2 lasers are feasible for microsurgical dissection of the deep lamella in deep sclerectomy.
- Excimer and CO2 lasers yield more regular and smoother tissue surfaces.
- The excimer laser offers the significant advantage of dissecting tissue without causing thermal damage, indicating its potential for safer glaucoma surgery.
