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    Flexible glaucoma procedure serves wide variety of patients

    CLASS procedure outcomes effective in reducing IOP, keeping better visual acuity

     

    Rate of success

    The success rate was 94.9%, and postoperative complications included early transient ocular hypertension (4%), which was resolved in all cases at 1 month postoperatively. During the first 9 months postoperatively, 18% of patients received laser goniopuncture, 12% had needling, and 5% had an iridectomy.

    It was concluded that CLASS was as effective as trabeculectomy, with fewer complications and better maintenance of visual acuity.

    While very effective as a stand-alone procedure, the CLASS procedure also yields excellent outcomes when combined with phacoemulsification in patients with comorbid cataract and glaucoma.

    For combined procedures, I perform a fornix-based periotomy and then create the 5- × 5-mm scleral flap prior to performing phacoemulsification.

    Once the cataract is removed and the new lens is in place, I return to the CLASS procedure, ablating the sclera until Schlemm’s canal is unroofed and then closing and suturing the conjunctiva.

    Following a combined CLASS + phacoemulsification procedure, my patients frequently have pressure near 5 mm Hg on the first day, but the anterior chambers remain full, rather than flat. Pressure normalizes between 1 and 3 weeks, usually between 10 and 13 mm Hg. The pressure reductions are very comparable to trabeculectomy, with fewer medications and fewer complications.

    Patients also have less inflammation compared with a trabeculectomy.

    My postoperative regimen consists of an antibiotic with dexamethasone for 10 days, then pilocarpine for 2 weeks, and prednisolone acetate (Pred Forte, Allergan) for 4 to 5 months. I see my patients at 1 day, 1 week, and 1 month postoperatively, and then every 2 to 3 months depending on how they are doing.

    Though cataract surgery alone is always best for ensuring refractive results, I have found that CLASS is not as negatively impactful as trabeculectomy on patients’ refractive outcomes. I use aspheric or toric lenses in this group and find that there is no impact on lens placement or rotation.

    Also, surgically induced astigmatism is less with CLASS than trabeculectomy, which helps achieve successful outcomes. Less inflammation means patients are seeing well and appreciating their new IOL in 2 to 3 days, rather than having blurry vision for 2 weeks as is common with trabeculectomy. Due to my overall success with the CLASS procedure, I no longer perform trabeculectomy.

     

    Reference

    1. Izquierdo JC, Quezada F, Corina M, Gonzalez Mendez AL. Clinical results of CO2 laser-assisted sclerectomy surgery (CLASS) and ologen implant compared to trabeculectomy and ologen implant in patients with refractory open-angle glaucoma. Presented at ASCRS annual meeting. Los Angeles, CA. May 2017.

     

     

     

     

    Juan Carlos Izquierdo, MD

    E: [email protected]

    Dr. Izquierdo is director of Glaucoma Services, Oftalmo Salud, Lima, Peru. He declares no financial disclosure related to IOPtima.

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