Internal sclerostomy with the Er:YAG laser using a gradient-index (GRIN) endoscope.
OBJECTIVE
To show that sclerostomy, a glaucoma filtering surgery, can be performed using an Er:YAG laser. Scarring at the filtering site, a recurrent problem, may be reduced through proper positioning of the sclerostomy by using an intraocular endoscope.


METHODS
Ab interno full-thickness sclerostomies were performed on eye bank eyes with an Er:YAG laser through a custom made optical delivery system. The intraocular laser probe consisted of a low OH silica fiber inserted in a metallic tapered sheathing. A rigid intraocular endoscope based on gradient-index lenses allowed visualization of the filtration site.


RESULTS
A clear view of the anterior chamber angle was obtained through the endoscope, allowing for precise location of the sclerostomy. Full-thickness sclerostomies could then be performed at the desired location. Histologic sections showed thermal necrosis less than 50 microm thick in tissue adjacent to the sclerostomy.


CONCLUSIONS
A sclerostomy performed with a combined procedure using an Er:YAG laser and intraocular endoscopy increases the speed of the procedure. The use of a high-resolution intraocular endoscope may increase the success rate of ab interno laser glaucoma surgeries.
Mizota
Atsushi
A
Department of Ophthalmology, Chiba University School of Medicine, Japan.
Takasoh
Michihiko
M
Kobayashi
Katsuhiko
K
Parel
Jean-Marie
JM
Manns
Fabrice
F
Rol
Pascal
P
D004724:Endoscopy; D005125:Eye Banks; D006801:Humans; D053685:Laser Therapy; D012590:Sclera / Q000473:pathology / Q000601:surgery; D012599:Sclerostomy / Q000379:methods*