Allan B D, van Saarloos P P, Cooper R L, Keogh E J, Constable I J
Lions Eye Institute, Nedlands, Western Australia.
Graefes Arch Clin Exp Ophthalmol. 1993 Nov;231(11):662-6. doi: 10.1007/BF00921962.
Excimer laser sclerostomy is a new glaucoma filtration procedure in which the argon fluoride excimer laser at 193 nm is delivered ab externo through a modified open mask system incorporating an en-face air jet to dry the target area and preserve hemostasis during ablation and a conjunctival plication mechanism, which allows the conjunctival and scleral wounds created by through-and-through ablation to separate once the mask is removed. No preparatory dissection of the conjunctiva is required. Five 200-microns and five 500-microns sclerostomies were formed by ablation at a pulse repetition rate of 20 Hz and a fluence per pulse of 400 mJ/cm2 in fellow eyes of five rhesus monkeys with experimental glaucoma. Overall, seven of the ten eyes attained a functional result, with intraocular pressures remaining below 21 mmHg for 6 +/- 1 days and rising to the pre-operative level after 10 +/- 3 days without adjunctive antifibroblast medication. The duration of filtration for 200-microns and 500-microns sclerostomies was similar, and parallels that previously observed for posterior lip sclerectomy in the same animal model. The three eyes with no functional result all had incorrectly positioned sclerostomies. Choroidal detachment and significant shallowing of the anterior chamber did not occur. Excimer laser sclerostomy appears to be a viable technique for filtration, provided that mask placement is accurate.
准分子激光巩膜造口术是一种新型青光眼滤过手术，在该手术中，波长为193nm的氟化氩准分子激光通过改良的开放式面罩系统从眼外引入，该系统包含一个用于干燥目标区域并在消融过程中保持止血的表面空气喷射装置以及一个结膜折叠机制，该机制可使在完全消融后形成的结膜和巩膜伤口在移除面罩后分离。无需对结膜进行预备性剥离。在五只患有实验性青光眼的恒河猴的对侧眼中，以20Hz的脉冲重复频率和每脉冲400mJ/cm²的能量密度进行消融，形成了五个200微米和五个500微米的巩膜造口。总体而言，十只眼中有七只获得了功能性结果，眼压在6±1天内保持在21mmHg以下，在10±3天后升至术前水平，无需辅助抗成纤维细胞药物治疗。200微米和500微米巩膜造口的滤过持续时间相似，与在同一动物模型中先前观察到的后唇巩膜切除术的滤过持续时间相当。三只无功能性结果的眼睛巩膜造口位置均不正确。未发生脉络膜脱离和前房明显变浅。只要面罩放置准确，准分子激光巩膜造口术似乎是一种可行的滤过技术。
