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Prospective evaluation of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C

  • Glaucoma
  • Published:
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Abstract

Purpose

Our purpose was to evaluate the clinical safety and efficacy of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C (MMC) in open angle glaucoma (OAG).

Methods

This was a prospective, uncontrolled, interventional case series. All subjects underwent CLASS procedure by a single surgeon. After the dissection of a partial thickness scleral flap, topical MMC 0.2 mg/ml was applied to the sclera and the conjunctiva for 3 min. The CO2 laser with a beam-manipulating system was used to ablate the scleral tissue and expose the Schlemm’s canal area. Primary outcomes: intraocular pressure (IOP) change, number of IOP-lowering medicaments change. Adverse events were evaluated as secondary outcomes.

Results

Twenty-one eyes of 21 patients underwent the CLASS procedure. Thirteen were primary OAG (62%), two normal pressure glaucoma (10%), three exfoliative glaucoma (14%) and three others secondary OAG. With a mean (SD) follow-up of 15.3 (5.9) months, the IOP changed from 25.4 (6.7) mmHg at baseline to 10.9 (3.4) mmHg al the last visit. Mean reduction of IOP was −14.5 mmHg (95% CI, −17.7 to −11.2, P < 0.001). The median (IQR) number of IOP-lowering medication decreased from 3 (3–3) at baseline to 1 (0–1) at the last visit (P < 0.001). Visual acuity did not change significantly. Adverse events: five eyes (24%) developed iris adhesion to the filtration area that was successfully managed with office-based procedures. In one case (5%), CLASS was converted to trabeculectomy due to intraoperative perforation of the ablated area. There was one case of hypotony maculopathy successfully treated with placement of additional transconjunctival scleral flap sutures.

Conclusions

The CLASS procedure with MMC is clinically safe and effective maintaining a large reduction in IOP and in the number of IOP-lowering medications with a mean follow-up of 15 months. Iris adhesion at the filtrating area warrants further evaluation and possibly reflects the surgeon’s learning curve.

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Authors and Affiliations

  1. Clinica Oculistica Università di Genova DiNOGMI - Ospedale Policlinico San Martino, Viale Benedetto XV, 5, 16136, Genoa, Italy

    Carlo Alberto Cutolo, Alessandro Bagnis, Riccardo Scotto, Chiara Bonzano & Carlo Enrico Traverso

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  1. Carlo Alberto Cutolo
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  2. Alessandro Bagnis
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  3. Riccardo Scotto
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  4. Chiara Bonzano
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  5. Carlo Enrico Traverso
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Correspondence to Carlo Alberto Cutolo.

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Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cutolo, C.A., Bagnis, A., Scotto, R. et al. Prospective evaluation of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C. Graefes Arch Clin Exp Ophthalmol 256, 181–186 (2018). https://doi.org/10.1007/s00417-017-3844-1

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  • DOI: https://doi.org/10.1007/s00417-017-3844-1

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