The Place of Transscleral Technologies in Laser Treatment of Glaucoma: History, Stages of Development, Prospects

Abstract

The presence of a balance between the production and outflow of intraocular fluid ensures stability of the level of intraocular pressure (IOP). To reduce IOP means to affect one of these variables. For many decades, transscleral technologies in the treatment of glaucoma were considered exclusively as traumatic cyclodestructive interventions that only affect the reduction of intraocular pressure (IOP). These methods have recently been considered as possible ways to influence uveoscleral outflow. This became possible due to the appearance of new lasers, the development of new modes of their operation, points of application in the projection of the pars plana of the ciliary body (for example, TRANS-scleral CFC in micro-pulse mode at λ = 810 µm and CFC using pulsed periodic laser radiation at λ = 1.56 µm). They have a gentler effect and, accordingly, cause fewer side effects and undesirable effects. This explains the increasing shift towards the use of transscleral technologies in the earlier stages of glaucoma, not only for end-stage painful glaucoma resistant to conventional treatment (so-called “last resort surgery”).