A clinical observation of carbon dioxide laser-assisted deep sclerectomy for Posner-Schlossman Syndrome

This study aimed to preliminarily evaluate the clinical efficacy and safety of carbon dioxide laser-assisted deep sclerectomy (CLASS) in patients with medically refractory Posner-Schlossman Syndrome (PSS).

Six patients (six eyes) with poorly controlled PSS were included. All patients underwent CLASS under local anesthesia and were followed up for 18 months. Primary outcome measures included intraocular pressure (IOP), best-corrected visual acuity (BCVA), retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thickness, visual field parameters, and surgical complications.

The mean preoperative IOP was 28.30 ± 5.16 mmHg. Postoperative IOP decreased significantly, with a mean IOP of 14.56 ± 1.82 mmHg at the final 18-month follow-up. Visual acuity recovered to or exceeded preoperative levels in all cases. No statistically significant differences were observed in RNFL or GCC thickness at any postoperative time point (6, 12, and 18 months) compared to preoperative values. Visual field indices (MD, PSD) remained stable throughout follow-up. Postoperative complications included transient hypotony (three eyes), peripheral anterior synechiae (two eyes, successfully treated with laser), transient shallow anterior chamber (one eye), and mild anterior chamber reaction (one eye). All complications were managed conservatively without sequelae, and no serious adverse events occurred.

CLASS surgery provides effective and sustained IOP reduction in patients with refractory PSS. It demonstrates favorable structural and functional preservation of the optic nerve over the mid-term follow-up, with a manageable profile of minor complications. These preliminary findings suggest CLASS is a promising minimally invasive surgical option for this condition, though its long-term efficacy warrants confirmation in larger prospective studies.