ESCRS 2020 Poster – CLASS: surgical technique and preliminary results

Poster Details

First Author: A.Lopez-Vazquez SPAIN

Co Author(s):    C. Fernández Alcalde   A. Ramos Castrillo   R. Larga Hontoria   J. Vila Arteaga   J. Larosa Poves   C. Lavín Dapena    

Abstract Details

Purpose:
To evaluate the efficacy of CO2 Laser-assisted Sclerectomy Surgery (CLASS) in open angle glaucoma (OAG) and describe different surgical variants of this technique.

Setting:
Ophthalmology Department of University Hospital La Paz, Madrid, Spain

Methods:
As part of a prospective, uncontrolled, multicentric, interventional case series, we performed and video-recorded 17 CLASS procedures by five different surgeons. Patients were followed up from a minimum of 3 months up to 9 months and evaluated on: preoperative intraocular pressure (IOP), IOP-lowering medications and postoperative IOP. Several surgical approaches were performed, as follows: usage of Mitomicyn or Ologen, usage of intraescleral implant, carving of intrascleral channel, size variation on treatment area and laser spot.

Results:
The mean preoperative IOP was 18,53 mmHg, under a mean of 2.53 antiglaucomatous drugs. After the CLASS procedure, we observed a mean postoperative IOP of 12.94 mmHg, 15.46 mmHg and 15 mmHg at 3, 6 and 9 months respectively. 3 months postoperatively only one patient required topical antiglaucomatous medication. In addition, at 6 months’ time three patients required topical antiglaucomatous medication, and two of them required an additional goniopunction. Only one complication was noticed, a microperforation and iris prolapse due to a thin scleral layer on one patient.

Conclusions:
The CO2 Laser-assisted sclerectomy surgery is an effective approach for OAG’s treatment. Laser-tissue interaction is directly dependent on the laser power and has a known and expected effect. Consequently, standardization of CLASS could be possible in a nearby future. We observed that the CLASS technique allows different surgical variations to obtain the best surgical outcome, in the same way as the classic manual non-penetrating deep sclerectomy. Being the laser’s power fixed, CLASS technique is a safe procedure with minimum chances of perforation, compared to the classical technique, which is able to reduce the learning curve for the surgeon.