Reply: efficacy and safety of CO2 laser-assisted sclerectomy surgery for glaucoma: a systematic review and meta-analysis

Dai, Li; Li, Ai Ling; Yu, Ling; Ye, Jian

doi:10.5935/0004-2749.202100111

Cited by 4 publications

(7 citation statements)

References 2 publications

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“…Due to its unique advantage, CO 2 laser was first applied by Assia et al as a simplified NPDS in 2007, named as CLASS (16). Clinical studies have demonstrated its efficacy and safety in patients with POAG (12). Table 4 summarizes long-term outcomes of CLASS among published studies.…”

Section: Discussionmentioning

confidence: 99%

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Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

Chen

Yang

et al. 2021

Front. Med.

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Purpose: To report the safety and efficiency of carbon dioxide (CO2) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation.Methods: This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions.Results: The mean age of the patient was 42.6 ± 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively.Conclusion: CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.

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Section: Discussionmentioning

confidence: 99%

“…It has been successfully used to treat primary open-angle glaucoma (POAG) during the recent years, both in the Caucasian and in Chinese patients (9)(10)(11). Compared with other filtering surgeries, CLASS requires a shorter learning curve and less technical challenge and also achieves higher safety (12).…”

Section: Introductionmentioning

confidence: 99%

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

Chen

Yang

et al. 2021

Front. Med.

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“…However, the incidence of shallow AC was relatively low in CLASS than in Trab for POAG patients, with an incidence of 1.5% vs. 6.2% in Caucasian ( 40 ) and 0% vs. 21.3% in Chinese patients ( 35 ). Complicated cataract has never been reported after CLASS in POAG patients among previous studies ( 41 ). In this case, we speculated that due to the maldevelopment of the TM tissue and poor elasticity of the iris, routine LGP treatment with moderate energy resulted in small tears in the thin TDM rather than micro perforation, which promoted overfiltering after CLASS and aggravated the occurrence of shallow AC and complicated cataract.…”

Section: Discussionmentioning

confidence: 81%

CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

Chen

Cheng

et al. 2022

Front. Med.

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IntroductionBilateral congenital ectropion uveae (CEU) is rare syndrome, usually accompanied by refractory glaucoma. Proper and timely treatment was very important for the prognosis. The report aims to compare the long-term outcomes and complications between the two eyes after different approaches of surgery in a case of bilateral CEU with advanced glaucoma.Case PresentationThe patient was a 20-year-old male with bilateral CEU and glaucoma. The intraocular pressure (IOP) was 48 mm Hg in the right eye (OD) and 52 mm Hg in the left eye (OS). The vertical cup-to-disc (C/D) ratio was nearly 1.0 in both eyes. Despite maximum medical therapy, the target IOP could not be achieved. Therefore, CO2 laser-assisted sclerectomy surgery (CLASS) was performed in OS, and the IOP was remarkably decreased. 1 month after the surgery, the IOP rebounded slightly and was controlled with a fixed-combination anti-glaucoma medicine. 3-month postoperatively, a YAG laser goniopuncture (LGP) was performed to enhance the IOP-lowing effect and the anti-glaucoma agent was discontinued. An ab externo microcatheter-assisted trabeculotomy (MAT) was performed in OD, and the IOP was also significantly decreased. During the follow-up period, the IOP was well controlled for both eyes without any medication. Shallow anterior chamber and complicated cataract developed in OS after CLASS, and there was no obvious late complication in OD after MAT.ConclusionsTo our knowledge, this was the first attempt to perform two different surgeries, CLASS and MAT, in both eyes of a single patient presented with bilateral CEU with glaucoma. Our results showed that the IOP was lower after CLASS, but there were potential complications such as shallow anterior chamber and complicated cataract. MAT could achieve a moderate IOP-lowing effect but had a higher safety. CLASS and MAT may be considered effective surgical options for the management of such patients.

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“…Recently, CLASS has been used to gradually lower IOP in patients with Primary Open Angle Glaucoma (POAG), pseudocapsular detachment syndrome, and secondary glaucoma (12)(13)(14). CLASS has a shorter learning curve, lower technical demands, and higher safety (15) than other filtering surgeries. Dai et al (15) evaluated the effectiveness and safety of CLASS for treating glaucoma by systematically reviewing and meta-analyzing related studies.…”

Section: Introductionmentioning

confidence: 99%

An overview and update of CO₂ laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review)

et al. 2023

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Glaucoma is the second leading cause of blindness worldwide. The proportion of cases of primary open-angle glaucoma (POAG) in China is gradually increasing. Glaucoma surgery has become more effective, safer, minimally invasive and personalized over the years. CO 2 laser-assisted sclerectomy surgery (CLASS) is a minimally invasive glaucoma treatment. CLASS has recently been used to gradually lower intraocular pressure (IOP) in patients with POAG, pseudocapsular detachment syndrome and secondary glaucoma. In this operation, precise ablation of dry tissue followed by photocoagulation and effective absorption of water and percolating aqueous humor using CO 2 laser are performed, and the IOP is lowered by the laser ablation of the deep sclera and the outer wall of the Schlemm's canal, facilitating the drainage of the aqueous humor. Compared with other filtering surgeries, CLASS has a shorter learning curve, lower technical difficulty and higher safety. The present study reviews the clinical application progress, safety and effectiveness of CLASS.

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Reply: efficacy and safety of CO2 laser-assisted sclerectomy surgery for glaucoma: a systematic review and meta-analysis

Cited by 4 publications

References 2 publications

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

An overview and update of CO₂ laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review)

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Reply: efficacy and safety of CO2 laser-assisted sclerectomy surgery for glaucoma: a systematic review and meta-analysis

Cited by 4 publications

References 2 publications

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma

CO2 Laser-Assisted Sclerectomy vs. Microcatheter-Assisted Trabeculotomy in the Management of a Bilateral Congenital Ectropion Uveae With Glaucoma: A Case Report and Literature Review

An overview and update of CO2 laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review)

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An overview and update of CO₂ laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review)