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Er:YAG-laser from Externo Sclerostomy Modified by Silicone Stent Implantation

1Kampmeier J., 2Müther P. S., 3Bentele A., 1Lang G. E., 3Schütte E., 1Lang G. K., 2Schrage N. F.,
1Universität Ulm, Augenklinik und Poliklinik (Ulm)
2RWTH Aachen, Universitätsaugenklinik (Aachen)
3Institut für Lasertechnologien in der Medizin und Meßtechnik (Ulm)

Purpose: The initially promising ab externo sclerostomy using the Er:YAG-laser could not push through the standard glaucoma techniques. The main disadvantage of this uncovered trepanation of the chamber angle was a frequent closure of the canal, caused by the scarring tendency of the episcleral tissue blocking the external canal ostium. The aim of this study is to maintain an intact corneoscleral canal during postoperative inflammatory processes by placing a temporary non-draining implant into the canal as a placeholder to obtain an open external ostium for a prolonged time after implant removal.
Material and methods: The silicone implant is shaped like a thin cylinder (Ø 300 µm) combined with a larger flat flap, produced in a brass mould. After performing sclerostomy in four rabbits, the stent ware placed into the sclerostomy canal with micro-tweezers. Implants were removed after six weeks. Two eyes were enucleated for histology of the canal immediately after implant removal, the other two eyes were enucleated three months later.
Results: The experiments showed a good surgical practicability of the stent placement and a high silicone acceptance of the subconjunctival tissue with no greater inflammatory signs. Histology of tissue morphology will be demonstrated. No further infections occurred postoperatively. Iris prolaps was found postoperatively after implant removal in one eye.
Conclusions: Stent implantation after ab externo sclerostomy could improve the postoperative outcome. Implantations into human eyes are now necessary for reliable long-term results. Furthermore, our next aim is to develop a soft, high-speed biodegradable implant, possibly simultaneously serving as a drug-delivery system, avoiding the stent explantation causing subsequent tissue manipulation and scarring.

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