Carlos Vergés | PubMed Health

PubMed2003

Laser cataract surgery: technique and clinical results.

PURPOSE: To study the effectiveness of an erbium:YAG (Er:YAG) laser in removing nuclei of various densities. SETTING: University clinic. METHODS: This nonrandomized prospective clinical study included 147 consecutive cataractous eyes: Group 1 (n = 71) had conventional ultrasound, and Group 2 (n = 76) had surgery with the Er:YAG laser. The 2 groups were further classified by cataract density. Patients were examined 6 months postoperatively to evaluate surgical time, intraocular pressure (IOP), pachymetry, endothelial cell loss, and visual acuity. RESULTS: With ultrasound cataract surgery, there were no significant changes in IOP compared with the preoperative measurements. Laser treatment of 3+ and 4+ cataracts resulted in IOP increases of 12.6% and 18.2%, respectively, compared with 1+ and 2+ cataracts (P<.001). Slight endothelial cell losses occurred in all cases. With ultrasound, the mean decrease was 2.8%, and with laser surgery, the results were similar except for a significant decrease of 13.4% with 4+ cataracts. There was a correlation between pachymetry and surgical time when the trauma related to surgical time and hydrodynamic flow in the anterior chamber was assessed. With ultrasound, the visual acuity was similar with all types of cataract; with the laser, similar normal values were seen with 1+ and 2+ cataracts but decreased values were seen with 3+ cataracts and lower values with 4+ cataracts-0.43 compared to 0.84 best corrected visual acuity with same-density cataracts treated with ultrasound (P<.0005). Patients with 4+ cataracts treated with the laser developed more complications than those treated with ultrasound. CONCLUSIONS: The Er:YAG laser was as effective and reliable as ultrasound in removing soft and medium-density cataracts. With dense cataracts, the surgical length produced more trauma and complications during laser treatment than during ultrasound treatment.

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PubMed2002

Laser-assisted deep sclerectomy.

PURPOSE: To study the clinical effectiveness of deep sclerectomy using the erbium:YAG (Er:YAG) laser in patients with open-angle glaucoma (OAG). SETTING: Department of Ophthalmology, Institut Universitari Dexeus, Universitat Autonoma de Barcelona, Barcelona, Spain. METHODS: This nonrandomized prospective clinical study was performed in 46 consecutive eyes with OAG. Seventeen patients had not received any treatment for glaucoma. Eight had received 1 medication; 14, 2 medications; and 7, 3 medications. The mean duration of treatment was 18.3 months +/- 9.4 (SD). After mitomycin-C 0.02% was administered for 2 minutes, a superficial 4.0 mm x 4.0 mm scleral flap was created and a deep 3.0 mm x 3.0 mm scleral ablation was performed with the Er:YAG laser. Schlemm's canal was removed, and the cornea was dissected to Descemet's membrane until aqueous humor percolated. The scleral flap and conjunctiva were closed. Postoperative follow-up examinations were done at 1, 3, and 7 days, 2, 3, and 4 weeks, and then every 3 months up to 15 months. RESULTS: The mean preoperative intraocular pressure (IOP) was 28.3 +/- 6.1 mm Hg. The mean postoperative IOP was 14.1 +/- 3.5 mm Hg at 24 hours, 16.3 +/- 4.2 mm Hg at 3 months, and 15.3 +/- 2.7 mm Hg at 15 months (P <.001). There were no statistically significant differences in IOP by sex or age. There was a statistically significant difference between patients receiving no medication and those who received more than 2 medications and a treatment period longer than 1 year preoperatively (P <.006). The presence of a filtering bleb was associated with a longer period of decreased IOP (P <.007). The success rate (IOP < or =18 mm Hg without medication) was 93.47% at 1 month and 84.78% at 15 months. The number of complications was significantly lower than in previous reports of trabeculectomy. One patient lost 2 lines of visual acuity because of cystoid macular edema. CONCLUSIONS: Deep sclerectomy using the Er:YAG laser was safe and effective in eyes with OAG. More studies are needed to analyze the mechanism of lowering IOP.

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