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Perspectives of Photo-ablative Trabecular Surgery
Dietlein T.,
Universität zu Köln, Zentrum für Augenheilkunde (Köln)
Selective trabecular surgery aims to improve the ocular facility by treating selectively the trabecular meshwork and leaving other uninvolved structures, e.g. conjunctiva and episclera, untouched. By use of an Erbium:YAG or an excimer laser in a contact mode the trabecular tissue can be removed ab-interno and Schlemm´s canal can be opened thus improving the ocular facility. Experimental and clinical studies of these procedures (LTA or ELT) have demonstrated a significant IOP decrease and a relatively low risk profile. The postoperative IOP is influenced by the episcleral venous pressure and is usually higher than following filtering surgery with antimetabolites. Therefore decision for antiglaucomatous photoablative surgery has to be taken carefully considering the intended individual target pressure. In combination with modern cataract surgery photoablative trabecular surgery reveals some essential advantages over combined Phaco-TE, because postoperative hypotony is avoided and this combined procedure can be continuously performed within a closed system. Histomorphology following Erbium:YAG laser trabecular ablation partially revealed evidence of incomplete photovaporization of the trabecular meshwork owing to the current surgical technique. In future new laser systems, e.g. ultrashort pulsed lasers, and innovations concerning a better intraoperative control, f.e. microendoscopy and ultrasound biomicroscopy, may help to optimize the morphologic results of photoablative trabecular surgery.