CO2 laser-assisted procedure showing long-term efficacy, safety

Reviewed by Noa Geffen, MD, and Michael Mimouni, MD

Tel Aviv, Israel-CO₂ laser-assisted sclerectomy (CLASS, IOPtima) is a safe technique providing long-term IOP control with a reduced need for topical medications, show findings from follow-up to 5 years in a multinational trial.

“We are fortunate to be caring for patients in an era of glaucoma surgical innovation, and newer microinvasive procedures offer benefits in terms of their safety profiles,” said Michael Mimouni, MD, Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel. “However most do not provide adequate IOP control over time in eyes with more advanced glaucoma.”

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CLASS, developed by Professor Ehud Assia, MD, Department of Ophthalmology, Meir Medical Center, Kfar- Saba, Israel, is a simplified filtration procedure that has a short learning curve.

Outcomes from the studies published by Noa Geffen, MD, principal investigator, and the international CLASS group, show that it can be performed with repeatable efficacy and safety in the hands of different surgeons, Dr. Mimouni noted.

“Now we look forward to confirming these promising results with more data,” he said.

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More about CLASS

CLASS is performed with a proprietary laser system (IOPtiMate, IOPtima) that includes a 10.6 µm CO₂ laser, a control unit, and a micro-manipulating scanner integrated with the surgical microscope.

After creating a peritomy and half-thickness scleral flap, the laser is used to ablate the zone directly above Schlemm’s canal in order to achieve deep scleral ablation and un-roofing of Schlemm’s canal. The laser ablates tissue layer by layer until percolation of fluid is visualized.

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CLASS requires a manual creation of a partial thickness scleral flap but overcomes the need to manually create the deeper flap, which is the more challenging step in the standard non-penetrating deep sclerectomy procedures.

“The CO₂ laser was chosen for this procedure because its wavelength effectively ablates dry tissue, but is highly absorbed by water,” Dr. Mimouni said. “The laser is used to ablate the deeper scleral layer until percolation is achieved, without perforation.”

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