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Development of a Probe for Eximer-Lasercanalostomy
1Burk R., 2Specht H., 3Walker R.,
1Augenklinik, Städtische Kliniken Bielefeld (Bielefeld)
2Ruprecht-Karls-Universität Heidelberg, Universitäts-Augenklinik (Heidelberg)
3Glautec AG (Nürnberg)
Success of microsurgery of primary open angle glaucoma is highly dependend on the amount of surgically induced postoperative wound healing. Minimal invasive procedures are designed to reduce outflow resistance without inducing significant scar formation. Laser-canalostomy (ab externo Eximer-Lasertrabekulotomy ELT) is a promising new intervention, in which a controlled photoablation of Schlemm-canalendothel and trabecular meshwork is performed from inside of the canal of Schlemm.
Methods: An Eximer-Laser (wavelength 308 nm; Glautec AG) was coupled with a Schlemm canal probe for ab externo ELT (total diameter 280 µm, quarzfiber diameter 100 µm)*. Probe curvature is approx. 7 mm, curved in nasal and temporal direction. Tissue ablation is perpendicular to the inner curvature, directed towards the anterior chamber. Photoenergy is applied using 20 pulses of 0,14 mJ, with a puls length of 60 ns. Testing of photoablation was performed in vitro on autopsy eyes. Clinically, lasercanalostomy was added to deep sclerectomy in two eyes.
Results: Probe placement into the canal of Schlemm was easily performed in vitro and in vivo. Scanning electron microscopy revealed tissue ablation of the trabecular meshwork with only minimal thermal reaction. Clinical application of photoablation was intra- and postoperatively uneventful, intraocular pressure (IOP) was reduced 30% from 20 mmHg under maximal medical therapy to readings of 14 and 15 mmHg without additional medication six weeks postoperatively.
Discussion: Our first results indicate that retrograde photoablation of the trabecular meshwork from the inside of the canal of Schlemm may allow for a controlled reduction of the outflow resistance. Further studies are necessary to assess the long term efficacy of the procedure.
*Patent 197 05 815, submitted 02-15-1997, granted 02-11-1999