Funk J, Schlunck G
Universitäts-Augenklinik Freiburg.
Ophthalmologe. 1998 Jan;95(1):33-6. doi: 10.1007/s003470050232.
Endoscopic erbium-YAG laser treatment is a new approach in glaucoma surgery. In contrast to conventional laser systems, the photoablative erbium-YAG laser allows microperforations of the trabecular meshwork without thermal side effects. We report our first preclinical trials using this new system.
We used the Endognost system (Schwind Co.). The device combines an endoscope and illumination fiber (0.5 mm diameter), laser fiber (0.5 mm) and a irrigation tube in one probe with a 1.1 mm external diameter. The Endognost system was tested in porcine and enucleated human eyes. All eyes were examined histologically.
The endoscopic view into the anterior chamber allows for precise allocation of the laser pulses. Using a single pulse mode with 10 mJ a micropuncture of the trabecular meshwork can be achieved without damaging the adjacent tissue. Using multiple pulses or higher energy levels leads to damage of the posterior wall of Schlemm's canal and to thermal side effects.
Endoscope guided erbium-YAG laser effects on trabecular tissue are comparable to those produced by a 308 nm excimer laser. Therefore, a similar reduction in intraocular pressure can be expected.
内镜铒-钇铝石榴石激光治疗是青光眼手术的一种新方法。与传统激光系统不同，光蚀性铒-钇铝石榴石激光可实现小梁网的微穿孔，且无热副作用。我们报告了使用这种新系统的首次临床前试验。
我们使用了Endognost系统（施温德公司）。该设备将内窥镜和照明光纤（直径0.5毫米）、激光光纤（0.5毫米）以及冲洗管集成在一个外径为1.1毫米的探头中。Endognost系统在猪眼和摘除的人眼上进行了测试。所有眼睛均进行了组织学检查。
通过内窥镜观察前房可精确确定激光脉冲的位置。使用单脉冲模式，能量为10毫焦时，可实现小梁网的微穿刺，且不会损伤相邻组织。使用多个脉冲或更高能量水平会导致施莱姆管后壁受损并产生热副作用。
内窥镜引导下铒-钇铝石榴石激光对小梁组织的作用与308纳米准分子激光产生的作用相当。因此，可以预期眼压会有类似程度的降低。
