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    Flexible glaucoma procedure serves wide variety of patients

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


    How it’s done

    CLASS is performed with a surgical system (IOPtiMate, IOPtima) that consists of a 10.6-μm wavelength CO2 laser accompanied by a micro-manipulating scanner and a control unit.

    First, a standard scleral flap (5 × 5 mm) is made in the clear cornea to create a bed that serves as a fluid reservoir.

    The laser then precisely and delicately ablates the sclera in a pre-selected grid pattern until Schlemm’s canal is “unroofed” and aqueous begins to percolate through a thin trabecular meshwork membrane. This automatically terminates the ablation process as the laser energy is absorbed by the percolated fluid. The scleral flap is then closed and the conjunctiva is sutured.

    This non-penetrating surgery serves patients with both open-angle and pseudoexfoliative glaucoma without the complications common when the globe is penetrated, such as hypotony, blebitis, foreign body sensation, or endophthalmitis.

    I recently reported on a comparative study of 49 eyes that underwent trabeculectomy compared with 39 eyes that underwent CLASS.1 All had refractory glaucoma and all also received a biodegradable collagen matrix implant (Ologen, Aeon Astron). In the trabeculectomy group, mean IOP at 1 year was 12.06 ± 1.43 mm Hg, compared with 19.22 ± 9.20 mm Hg preoperatively. This group had an overall success rate of 85.7%.

    Postoperative complications included athalamia 4%, hemorrhagic detachment 2%, choroidal detachment 2%, and 5% needed additional surgery due to persistently high IOP.

    In the group that received the CLASS procedure, mean IOP at 1 year was 12.54 ± 1.51 mm Hg compared with 22.87 ± 9.17 mm Hg at baseline.

    Rate of success

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