Abstract:BackgroundTo evaluate the effects on near and intermediate visual performance after bilateral Laser Anterior Ciliary Excision (LaserACE) procedure.MethodsLaserACE surgery was performed using the VisioLite 2.94 μm erbium: yttrium–aluminum–garnet (Er:YAG) ophthalmic laser system in 4 oblique quadrants on the sclera over the ciliary muscle in 3 critical zones of physiological importance (over the ciliary muscles and posterior zonules) with the aim to improve natural dynamic accommodative forces. LaserACE was perf… Show more
“…15,16 A preliminary study on 52 eyes with 24-month follow-up after the LaserACE reported that the binocular UNVA, binocular distance-corrected near visual acuity, and stereoacuity significantly improved postoperatively, and there was no significant change of best-corrected distance visual acuity. 17 However, the underlying wound remodeling that may affect the treatment efficacy and stability has not been elucidated.…”
Section: Discussionmentioning
confidence: 99%
“…26 Cadaveric porcine eyes were used to optimize the laser intensity with respect to the depth of the micropores, which will affect the treatment efficacy. 16,17 The micropores were at approximately 63.5% of scleral thickness when the intensity was set at 12 pulses/pore.…”
To investigate the postoperative inflammatory and wound-healing responses after laser scleral microporation for presbyopia. Methods: Thirty porcine eyes were used for the optimization of laser intensities first. Six monkeys (12 eyes) received scleral microporation with an erbium yttrium aluminum garnet (Er:YAG) laser, and half of the eyes received concurrent subconjunctival collagen gel to modulate wound-healing response. The intraocular pressure (IOP) and the laser ablation depth were evaluated. The animals were euthanized at 1, 6, and 9 months postoperatively. The limbal areas and scleras were harvested for histologic analysis and immunofluorescence of markers for inflammation (CD11b and CD45), wound healing (CD90, tenascin-C, fibronectin, and HSP47), wound contraction (α-smooth muscle actin [α-SMA]), vascular response (CD31), nerve injury (GAP43), and limbal stem cells (P63 and telomerase). Results: In the nonhuman primate study, there was a significant reduction in IOP after the procedure. Overall, the ablation depth was 76.6% to 81.2% at 1 month and slightly decreased to 71.5% to 72.7% at 9 months. Coagulative necrosis around the micropores, as well as expression of CD11b, CD45, tenascin, fibronectin, HSP47, and GAP43, was distinct at 1 month but subsided with time. Collagen gel treatment significantly suppressed the upregulation of CD11b, CD45, fibronectin, and tenascin-C. The expression of CD90, α-SMA, and CD31 was minimal in all eyes. Conclusions: The study demonstrated the course of inflammatory and wound-healing responses following laser scleral microporation. The tissue responses were small and self-limited, resolved with time, and were suppressed by concurrent collagen treatment. It provides a useful understanding of this new procedure. Translational Relevance: The results would be helpful in the laser parameter modification to improve the long-term treatment stability.
“…15,16 A preliminary study on 52 eyes with 24-month follow-up after the LaserACE reported that the binocular UNVA, binocular distance-corrected near visual acuity, and stereoacuity significantly improved postoperatively, and there was no significant change of best-corrected distance visual acuity. 17 However, the underlying wound remodeling that may affect the treatment efficacy and stability has not been elucidated.…”
Section: Discussionmentioning
confidence: 99%
“…26 Cadaveric porcine eyes were used to optimize the laser intensity with respect to the depth of the micropores, which will affect the treatment efficacy. 16,17 The micropores were at approximately 63.5% of scleral thickness when the intensity was set at 12 pulses/pore.…”
To investigate the postoperative inflammatory and wound-healing responses after laser scleral microporation for presbyopia. Methods: Thirty porcine eyes were used for the optimization of laser intensities first. Six monkeys (12 eyes) received scleral microporation with an erbium yttrium aluminum garnet (Er:YAG) laser, and half of the eyes received concurrent subconjunctival collagen gel to modulate wound-healing response. The intraocular pressure (IOP) and the laser ablation depth were evaluated. The animals were euthanized at 1, 6, and 9 months postoperatively. The limbal areas and scleras were harvested for histologic analysis and immunofluorescence of markers for inflammation (CD11b and CD45), wound healing (CD90, tenascin-C, fibronectin, and HSP47), wound contraction (α-smooth muscle actin [α-SMA]), vascular response (CD31), nerve injury (GAP43), and limbal stem cells (P63 and telomerase). Results: In the nonhuman primate study, there was a significant reduction in IOP after the procedure. Overall, the ablation depth was 76.6% to 81.2% at 1 month and slightly decreased to 71.5% to 72.7% at 9 months. Coagulative necrosis around the micropores, as well as expression of CD11b, CD45, tenascin, fibronectin, HSP47, and GAP43, was distinct at 1 month but subsided with time. Collagen gel treatment significantly suppressed the upregulation of CD11b, CD45, fibronectin, and tenascin-C. The expression of CD90, α-SMA, and CD31 was minimal in all eyes. Conclusions: The study demonstrated the course of inflammatory and wound-healing responses following laser scleral microporation. The tissue responses were small and self-limited, resolved with time, and were suppressed by concurrent collagen treatment. It provides a useful understanding of this new procedure. Translational Relevance: The results would be helpful in the laser parameter modification to improve the long-term treatment stability.
“…The primary risk is accidental micro perforation of the sclera, however, the advantage of this procedure is that the cornea and the crystalline remains untouched and allows LaserACE ® to be performed after or even in combination with other procedures. [ 134 ]…”
Presbyopia results from loss or insufficiency of the eye's accommodative ability, and clinically manifests as the inability to focus near objects on the retina. It is one of the most common causes of visual impairment worldwide especially in adults of productive or working age. Various means of compensating for the loss of accommodative ability have been devised from optical tools such as spectacles and contact lenses, to topical medications and to surgical procedures. A comprehensive search on journal articles about topical and surgical correction of presbyopia was undertaken. The various techniques for presbyopia correction, as enumerated in these articles, are discussed in this paper with the addition of our personal experience and perspective on the future of these techniques.
“…a ) The three critical zones of significance as measured from the anatomical limbus; b ) Restored mechanical efficiency and improved biomechanical mobility (procedure objectives). Reprinted with permission from [ 50 ] Fig. 3 LaserACE surgical technique.…”
Section: Reviewmentioning
confidence: 99%
“…Photo a ) Quadrant marker; b ) Matrix marker; c ) Corneal Shield; d ) LaserACE micropore ablation; e ) Subconjunctival Collagen f ) Completed 4 quadrants. Reprinted with permission from [ 50 ] Fig. 4 Uncorrected (lightly colored) and distance-corrected (darkly colored) visual acuity at a distance 4 m, intermediate (60 cm), and near (40 cm) for a ) Monocular and b ) Binocular patient eyes.…”
Presbyopia corrections traditionally have been approached with attempts to exchange power, either at the cornea or the lens planes, inducing multifocality, or altering asphericity to impact the optical system. Treatments that affect the visual axis, such as spectacle and contact lens correction, refractive surgeries, corneal onlays and inlays, and intraocular lenses are typically unable to restore true accommodation to the presbyopic eye. Their aim is instead to enhance ‘pseudoaccommodation’ by facilitating an extended depth-of-focus for which vision is sufficient. There is a true lack of technology that approaches presbyopia from a treatment based or therapy based solution, rather than a ‘vision correction’ solution that compromises other components of the optical system. Scleral surgical procedures seek to restore true accommodation combined with pseudoaccommodation and have several advantages over other more invasive options to treat presbyopia. While the theoretical justification of scleral surgical procedures remains controversial, there has nevertheless been increasing interest and evidence to support scleral surgical and therapeutic approaches to treat presbyopia. Enormous progress in scleral surgery techniques and understanding of the mechanisms of action have been achieved since the 1970s, and this remains an active area of research. In this article, we discuss the historic scleral surgical procedures, the two scleral procedures currently available, as well as an outlook of the future for the scleral surgical space for treating presbyopia.
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