Laser sclerostomy ab externo using two different infrared lasers: a clinical comparison

Area of Science:

• Ophthalmology
• Surgical Technology
• Laser Medicine

Background:

• Glaucoma management often requires surgical intervention to reduce intraocular pressure.
• Laser sclerostomy is a minimally invasive surgical approach for glaucoma.
• Different laser sources may offer varying clinical outcomes and safety profiles.

Purpose of the Study:

• To compare the clinical efficacy and safety of erbium-YAG (Er:YAG) and holmium:YAG (Ho:YAG) lasers in ab externo laser sclerostomy.
• To evaluate the impact of laser energy absorption and penetration depth on surgical outcomes.

Main Methods:

• A prospective study involving 26 patients with advanced open-angle glaucoma.
• Comparison of pulsed Er:YAG (2940 nm) and Ho:YAG (2120 nm) lasers delivered via a 300-micron fiber.
• Ab externo laser sclerostomy performed near the limbus with fiber contact to the sclera.
• Follow-up for up to 6 months to assess intraocular pressure, fistula patency, and complications.

Main Results:

• Both laser types achieved a functioning fistula and significant intraocular pressure reduction (to <10 mm Hg) in all patients.
• Er:YAG laser required approximately four times less total energy compared to Ho:YAG.
• No intraoperative complications were observed.
• Postoperative complications included reversible iris adherence (60% with Ho:YAG) and small hyphemas (30% with Er:YAG).
• Fistula patency was approximately 40% in both groups after 6 months.

Conclusions:

• Both Er:YAG and Ho:YAG lasers are suitable for ab externo laser sclerostomy.
• Despite differing thermal effects and complication rates, the overall clinical success rate was similar between the two laser modalities.
• Further research may optimize laser parameters for improved long-term outcomes.