An overview and update of CO<sub>2</sub> laser‑assisted sclerectomy surgery in primary open angle glaucoma (Review)

Huang,Chunlian; Shen,Xiao; Chen,Min; Wang,Kaijun

doi:10.3892/etm.2023.11969

June-2023 Volume 25 Issue 6

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June-2023 Volume 25 Issue 6

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Review

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

Authors:
- Chunlian Huang
- Xiao Shen
- Min Chen
- Kaijun Wang
View Affiliations / Copyright

Affiliations: Department of Ophthalmology, Taizhou Central Hospital, Taizhou University Hospital, Taizhou, Zhejiang 318000, P.R. China, Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310009, P.R. China
Article Number: 270
|
Published online on: April 20, 2023

https://doi.org/10.3892/etm.2023.11969
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Abstract

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. CO₂ 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 CO₂ 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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1	Quigley HA: Glaucoma. Lancet. 377:1367–1377. 2011.PubMed/NCBI View Article : Google Scholar
2	Zhang N, Wang J, Li Y and Jiang B: Prevalence of primary open angle glaucoma in the last 20 years: A meta-analysis and systematic review. Sci Rep. 11(13762)2021.PubMed/NCBI View Article : Google Scholar
3	Schuster AK, Erb C, Hoffmann EM, Dietlein T and Pfeiffer N: The diagnosis and treatment of glaucoma. Dtsch Arztebl Int. 117:225–234. 2020.PubMed/NCBI View Article : Google Scholar
4	Hoffmann EM, Hengerer F, Klabe K, Schargus M, Thieme H and Voykov B: Glaucoma surgery today. Ophthalmologe. 118:239–247. 2021.PubMed/NCBI View Article : Google Scholar : (In German).
5	Jampel HD, Solus JF, Tracey PA, Gilbert DL, Loyd TL, Jefferys JL and Quigley HA: Outcomes and bleb-related complications of trabeculectomy. Ophthalmology. 119:712–722. 2012.PubMed/NCBI View Article : Google Scholar
6	Hondur A, Onol M and Hasanreisoglu B: Non-penetrating glaucoma surgery: Meta-analysis of recent results. J Glaucoma. 17:139–146. 2008.
7	Cheng JW, Cheng SW, Cai JP, Li Y and Wei RL: Systematic overview of the efficacy of non penetrating glaucoma surgery in the treatment of open angle glaucoma. Med Sci Monit. 17:RA155–RA163. 2011.
8	Slagle G, Groth SL, Montelongo M and Sponsel WE: Non-penetrating deep sclerectomy for progressive glaucoma: Long-term (5-year) follow-up of intraocular pressure control and visual field survival. J Curr Glaucoma Pract. 14:3–9. 2020.PubMed/NCBI View Article : Google Scholar
9	Elhofi A and Helaly HA: Non-penetrating deep sclerectomy versus trabeculectomy in primary congenital glaucoma. Clin Ophthalmol. 14:1277–1285. 2020.PubMed/NCBI View Article : Google Scholar
10	Geffen N, Assia EI and Melamed S: Laser-Assisted techniques for penetrating and non-penetrating glaucoma surgery. Dev Ophthalmol. 59:100–112. 2017.PubMed/NCBI View Article : Google Scholar
11	Geffen N, Mimouni M, Sherwood M and Assia EI: Mid-term clinical results of CO₂ laser-assisted Sclerectomy Surgery (CLASS) for open-angle glaucoma treatment. J Glaucoma. 25:946–951. 2016.PubMed/NCBI View Article : Google Scholar
12	Jankowska-Szmul J, Dobrowolski D and Wylegala E: CO₂ laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up. Acta Ophthalmol. 96:e582–e591. 2018.PubMed/NCBI View Article : Google Scholar
13	Ho DCW, Perera SA, Hla MH and Ho CL: Evaluating CO₂ laser-assisted sclerectomy surgery with mitomycin C combined with or without phacoemulsification in adult Asian glaucoma subjects. Int Ophthalmol. 41:1445–1454. 2021.PubMed/NCBI View Article : Google Scholar
14	Zhang H, Tang Y, Yan X, Ma L, Geng Y, Li F and Tang G: CO₂ laser-assisted deep sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma: Two-year results. J Ophthalmol. 2021(6639583)2021.PubMed/NCBI View Article : Google Scholar
15	Dai L, Li AL, Yu L and Ye J: Reply: Efficacy and safety of CO₂ laser-assisted sclerectomy surgery for glaucoma: A systematic review and meta-analysis. Arq Bras Oftalmol. 84:418–420. 2021.PubMed/NCBI View Article : Google Scholar
16	Argento C, Sanseau AC, Badoza D and Casiraghi J: Deep sclerectomy with a collagen implant using the excimer laser. J Cataract Refract Surg. 27:504–506. 2001.PubMed/NCBI View Article : Google Scholar
17	Klink T, Lieb W and Grehn F: Erbium-YAG laser-assisted preparation of deep sclerectomy. Graefes Arch Clin Exp Ophthalmol. 238:792–796. 2000.PubMed/NCBI View Article : Google Scholar
18	Schuman JS, Chang W, Wang N, de Kater AW and Allingham RR: Excimer laser effects on outflow facility and outflow pathway morphology. Invest Ophthalmol Vis Sci. 40:1676–1680. 1999.PubMed/NCBI
19	Traverso CE, Murialdo U, Di Lorenzo G, Venzano D, De Palma G, Gandolfo E, Calabria GA and Zingirian M: Photoablative filtration surgery with the excimer laser for primary open-angle glaucoma: A pilot study. Int Ophthalmol. 16:363–365. 1992.PubMed/NCBI View Article : Google Scholar
20	Assia EI, Rotenstreich Y, Barequet IS, Apple DJ, Rosner M and Belkin M: Experimental studies on non-penetrating filtration surgery using the CO₂ laser. Graefes Arch Clin Exp Ophthalmol. 245:847–854. 2007.PubMed/NCBI View Article : Google Scholar
21	Ton Y, Geffen N, Kidron D, Degani J and Assia EI: CO₂ laser-assisted sclerectomy surgery part I: Concept and experimental models. J Glaucoma. 21:135–140. 2012.PubMed/NCBI View Article : Google Scholar
22	Geffen N, Ton Y, Degani J and Assia EI: CO₂ laser-assisted sclerectomy surgery, Part II: Multicenter clinical preliminary study. J Glaucoma. 21:193–198. 2012.PubMed/NCBI View Article : Google Scholar
23	Greifner G, Roy S and Mermoud A: Results of CO₂ laser-assisted deep sclerectomy as compared with conventional deep sclerectomy. J Glaucoma. 25:e630–e638. 2016.PubMed/NCBI View Article : Google Scholar
24	Yick DWF, Lee JWY, Tsang S, Yeung BYM and Yuen CYF: Preliminary results of CO₂ laser-assisted sclerectomy surgery (CLASS) in the treatment of advanced glaucoma in a Chinese population. Medicine (Baltimore). 95(e5294)2016.PubMed/NCBI View Article : Google Scholar
25	Yu X, Chen C, Sun M, Dong D, Zhang S, Liu P, Yuan R and Ye J: CO₂ laser-assisted deep sclerectomy combined with phacoemulsification in patients with primary open-angle glaucoma and cataract. J Glaucoma. 27:906–909. 2018.PubMed/NCBI View Article : Google Scholar
26	Zhang Y and Cheng G: Modified CO₂ laser-assisted sclerectomy surgery in Chinese patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A Two-year follow-up study. J Glaucoma. 29:367–373. 2020.PubMed/NCBI View Article : Google Scholar
27	Prum BE Jr, Rosenberg LF, Gedde SJ, Mansberger SL, Stein JD, Moroi SE, Herndon LW Jr, Lim MC and Williams RD: Primary open-angle glaucoma Preferred Practice Pattern(®) Guidelines. Ophthalmology. 123:P41–P111. 2016.PubMed/NCBI View Article : Google Scholar
28	Zhang Y, Mao J, Zhou Q, Li L, Zhang S, Bian A and Cheng G: Comparison of long-term effects after modified CO₂ laser-assisted deep sclerectomy and conventional trabeculectomy in chinese primary open-angle glaucoma. Ophthalmol Ther. 11:321–331. 2022.PubMed/NCBI View Article : Google Scholar
29	Bettin P and Di Matteo F: Postoperative management of penetrating and non-penetrating external filtering procedures. Dev Ophthalmol. 59:53–66. 2017.PubMed/NCBI View Article : Google Scholar
30	Shaarawy T, Mansouri K, Schnyder C, Ravinet E, Achache F and Mermoud A: Long-term results of deep sclerectomy with collagen implant. J Cataract Refract Surg. 30:1225–1231. 2004.PubMed/NCBI View Article : Google Scholar
31	Heuer DK, Parrish RK II, Gressel MG, Hodapp E, Palmberg PF and Anderson DR: 5-fluorouracil and glaucoma filtering surgery: II. A pilot study. Ophthalmology. 91:384–394. 1984.PubMed/NCBI View Article : Google Scholar
32	Romano JH, Hitchings RA and Pooinasawmy D: Role of Nd:YAG peripheral iridectomy in the management of ocular hypertension with a narrow angle. Ophthalmic Surg. 19:814–816. 1988.PubMed/NCBI View Article : Google Scholar
33	Mermou A, Karlen ME, Schnyder CC, Sickenberg M, Chiou AG, Hédiguer SE and Sanchez E: Nd:Yag goniopuncture after deep sclerectomy with collagen implant. Ophthalmic Surg Lasers. 30:120–125. 1999.PubMed/NCBI
34	Lee RY, Chon BH and Lin SC, He M and Lin SC: Association of ocular conditions with narrow angles in different ethnicities. Am J Ophthalmol. 160:506–515 e1. 2015.PubMed/NCBI View Article : Google Scholar
35	Xin Z, Chen J, Wang D, Wu X and Han Y: CO₂ laser-assisted sclerectomy surgery in the treatment of open-angle glaucoma in Chinese patients. Eur J Ophthalmol: Jan 12, 2022 (Epub ahead of print).
36	Chen M, Gu Y, Yang Y, Zhang Q, Liu X and Wang K: Management of intraocular pressure elevation after CO₂ laser-assisted sclerectomy surgery in patients with primary open-angle glaucoma. Front Med (Lausanne). 8(806734)2021.PubMed/NCBI View Article : Google Scholar
37	Villavicencio JCI, Baltodano FPQ, Ramirez Jimenez IM, Mendez ALG and Ponte-Davila MC: Comparative clinical results of phacoemulsification combined with CO₂ Laser-Assisted Sclerectomy vs. Phacoemulsification combined with trabeculectomy in patients with open-angle glaucoma. J Clin Exp Ophthalmol. 9(5)2018.
38	Chen M, Yu N, Huang C, Zhang Q, Liu X and Wang K: CO₂ Laser-Assisted sclerectomy surgery alone or combined with phacoemulsification in primary open-angle glaucoma: Comparison of 1-year outcomes. Ophthalmol Ther. 11:1719–1733. 2022.PubMed/NCBI View Article : Google Scholar
39	Johnson DH and Johnson M: Glaucoma surgery and aqueous outflow: How does nonpenetrating glaucoma surgery work? Arch Ophthalmol. 120:67–70. 2002.PubMed/NCBI View Article : Google Scholar
40	Yan X, Zhang H, Li F, Ma L, Geng Y and Tang G: Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: A 2-year follow-up. Eye (Lond). 35:2283–2293. 2021.PubMed/NCBI View Article : Google Scholar
41	Jankowska-Szmul J and Wylegala E: The CLASS surgical site characteristics in a clinical grading scale and anterior segment optical coherence tomography: A one-year follow-up. J Healthc Eng. 2018(5909827)2018.PubMed/NCBI View Article : Google Scholar
42	Mavrakanas N, Mendrinos E and Shaarawy T: Postoperative IOP is related to intrascleral bleb height in eyes with clinically flat blebs following deep sclerectomy with collagen implant and mitomycin. Br J Ophthalmol. 94:410–413. 2010.PubMed/NCBI View Article : Google Scholar
43	Fernández-Buenaga R, Rebolleda G, Casas-Llera P, Muñoz-Negrete FJ and Pérez-López M: A comparison of intrascleral bleb height by anterior segment OCT using three different implants in deep sclerectomy. Eye (Lond). 26:552–556. 2012.PubMed/NCBI View Article : Google Scholar
44	Roters S, Lüke C, Jonescu-Cuypers CP, Engels BF, Jacobi PC, Konen W and Krieglstein GK: Ultrasound biomicroscopy and its value in predicting the long term outcome of viscocanalostomy. Br J Ophthalmol. 86:997–1001. 2002.PubMed/NCBI View Article : Google Scholar
45	Chihara E, Okazaki K, Takahashi H, Shoji T, Adachi H and Hayashi K: Modified deep sclerectomy (D-lectomy MMC) for primary open-angle glaucoma: Preliminary results. J Glaucoma. 18:132–139. 2009.PubMed/NCBI View Article : Google Scholar
46	Khairy HA, Atta HR, Green FD, van der Hoek J and Azuara-Blanco A: Ultrasound biomicroscopy in deep sclerectomy. Eye (Lond). 19:555–560. 2005.PubMed/NCBI View Article : Google Scholar
47	Chihara E and Hayashi K: Relation between the volume of the lake and intraocular pressure reduction after nonfiltering glaucoma surgery: A spectral-domain anterior segment optical coherence tomography study. J Glaucoma. 20:497–501. 2011.PubMed/NCBI View Article : Google Scholar
48	Park M, Tanito M, Nishikawa M and Chihara E: Ultrasound biomicroscopy of intrascleral lake after viscocanalostomy and cataract surgery. J Glaucoma. 13:472–478. 2004.PubMed/NCBI View Article : Google Scholar
49	Emi K, Pederson JE and Toris CB: Hydrostatic pressure of the suprachoroidal space. Investig Ophthalmol Vis Sci. 30:233–238. 1989.PubMed/NCBI
50	Gedde SJ, Schiffman JC, Feuer WJ, Herndon LW, Brandt JD and Budenz DL: Tube Versus Trabeculectomy Study Group. Three-Year Follow-up of the Tube Versus Trabeculectomy Study. Am J Ophthalmol. 148:670–684. 2009.PubMed/NCBI View Article : Google Scholar
51	Cutolo CA, Bagnis A, Scotto R, Bonzano C and Traverso CE: Prospective evaluation of CO₂ laser-assisted sclerectomy surgery (CLASS) with Mitomycin C. Graefes Arch Clin Exp Ophthalmol. 256:181–186. 2018.PubMed/NCBI View Article : Google Scholar
52	Skaat A, Goldenfeld M, Cotlear D and Melamed S: CO₂ laser-assisted deep sclerectomy in glaucoma patients. J Glaucoma. 23:179–184. 2014.PubMed/NCBI View Article : Google Scholar
53	Sohajda Z, Széll N, Revák Á, Papp J and Tóth-Molnár E: Retinal nerve fibre layer thickness change after CO₂ laser-assisted deep sclerectomy surgery. Clin Ophthalmol. 14:1749–1757. 2020.PubMed/NCBI View Article : Google Scholar
54	Raja SV, Ponnat AK, Balagiri K and Pallamparthy S: Retrospective analysis of the comparison between carbon dioxide laser-assisted deep sclerectomy combined with phacoemulsification and conventional trabeculectomy with phacoemulsification. Indian J Ophthalmol. 69:2741–2745. 2021.PubMed/NCBI View Article : Google Scholar

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