Long-term results of Erbium YAG-laser-assisted deep sclerectomy

Abstract

Purpose: To evaluate the long-term results of Erbium YAG-laser-assisted deep sclerectomy (DS). In this procedure, the delicate dissection of a deep corneoscleral lamella is greatly simplified by using the Erbium YAG-laser. Methods: Data of 14 consecutive patients (10 male, four female, age 67.7±10.4 years), who underwent surgery from 1999 to 2000 were analysed retrospectively. The procedure was begun as a standard DS. The deep corneoscleral lamella was dissected with a pulsed Erbium YAG-laser (energy: 40-100mJ, frequency: 5-10Hz). Schlemm's canal was unroofed and the lamella thinned until aqueous percolated continuously through the membrane. Results: The mean follow-up time was 50.4±6.8 months. The mean preoperative intraocular pressure (IOP) was 37.7±10.5 mmHg. The mean postoperative IOP was 16.1±3.9 mmHg at 1 month, 15.1±4.3 mmHg at 3 months, 16.4±4.5 mmHg at 12 months, and 17.6±8.7 mmHg at 50.5 months. The complete success rates (IOP≤21 mmHg+IOP reduction ≥20% without glaucoma medication) were 83.3% at 3 months and 50% at 12 and 50.5 months. Rates for qualified success (IOP≤21 mmHg+IOP reduction ≥20% with glaucoma medication) were 91.7% at 3 months, 92.9% at 12 months, and 78.6% at 50.5 months. The number of glaucoma medications was reduced from 3.07±0.92 preoperatively to 1.14±1.41 at 50.5 months. A single case of anterior-chamber penetration, requiring iridectomy, was the only intraoperative complication. Conclusions: Erbium YAG-laser-assisted DS has the advantage of a greatly simplified dissection, while offering a successful long-term IOP control comparable to conventional DS.