{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,5]],"date-time":"2026-02-05T06:02:25Z","timestamp":1770271345273,"version":"3.49.0"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T00:00:00Z","timestamp":1640304000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p><jats:bold>Purpose:<\/jats:bold> To report the safety and efficiency of carbon dioxide (CO<jats:sub>2<\/jats:sub>) laser-assisted sclerectomy surgery (CLASS) in Chinese patients with primary open-angle glaucoma (POAG) and the management of unexpected postoperative intraocular pressure (IOP) elevation.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> This was a prospective case series study. A total of 23 eyes from 23 patients with POAG who underwent CLASS were involved and followed-up for 12 months. The primary outcomes included the changes in best corrected visual acuity (BCVA), IOP, and medications before and after CLASS. The secondary outcomes were success rate and postoperative laser interventions.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> The mean age of the patient was 42.6 \u00b1 16.0 years. There was no significant change in BCVA and visual field at baseline and 12 months after CLASS. The number of medications was significantly reduced after CLASS. The IOP was also significantly decreased and remained well controlled during the follow-up period, except for a transient elevation at 1 month postoperatively, due to the occurrence of peripheral anterior synechiae (PAS). Generally, 17 patients (73.9%) were treated with neodymium-doped yttrium aluminum garnet (Nd:YAG) laser synechiolysis to remove iris obstruction in the filtration site and seven patients (30.4%) underwent Nd:YAG laser goniopuncture to deal with scleral reservoir reduction. Only one patient (4.3%) received surgical repositioning due to iris incarceration. The complete success rate and total success rate at 12 months were 69.6 and 95.7%, respectively.<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> CLASS was a safe and effective approach for Chinese patients with POAG. Peripheral anterior synechiae (PAS), iris incarceration, and scleral reservoir reduction were common causes of unexpected postoperative IOP elevation. Individualized Nd:YAG laser intervention helps to improve the long-term outcomes after CLASS.<\/jats:p>","DOI":"10.3389\/fmed.2021.806734","type":"journal-article","created":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T09:08:21Z","timestamp":1640336901000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":6,"title":["Management of Intraocular Pressure Elevation After CO2 Laser-Assisted Sclerectomy Surgery in Patients With Primary Open-Angle Glaucoma"],"prefix":"10.3389","volume":"8","author":[{"given":"Min","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuxiang","family":"Gu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yumei","family":"Yang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qi","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xin","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaijun","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,24]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"13762","DOI":"10.1038\/s41598-021-92971-w","article-title":"Prevalence of primary open angle glaucoma in the last 20 years: a meta-analysis and systematic review","volume":"11","author":"Zhang","year":"2021","journal-title":"Sci Rep."},{"key":"B2","doi-asserted-by":"publisher","first-page":"225","DOI":"10.3238\/arztebl.2020.0225","article-title":"The diagnosis and treatment of glaucoma","volume":"117","author":"Schuster","year":"2020","journal-title":"Dtsch Arztebl Int."},{"key":"B3","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s00347-020-01146-x","article-title":"Glaucoma surgery today","volume":"118","author":"Hoffmann","year":"2021","journal-title":"Ophthalmologe."},{"key":"B4","doi-asserted-by":"publisher","first-page":"712","DOI":"10.1016\/j.ophtha.2011.09.049","article-title":"Outcomes and bleb-related complications of trabeculectomy","volume":"119","author":"Jampel","year":"2012","journal-title":"Ophthalmology."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.2147\/OPTH.S253689","article-title":"Non-penetrating deep sclerectomy versus trabeculectomy in primary congenital glaucoma","volume":"14","author":"Elhofi","year":"2020","journal-title":"Clin Ophthalmol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"3","DOI":"10.5005\/jp-journals-10078-1273","article-title":"Nonpenetrating deep sclerectomy for progressive glaucoma: long-term (5-year) follow-up of intraocular pressure control and visual field survival","volume":"14","author":"Slagle","year":"2020","journal-title":"J Curr Glaucoma pract."},{"key":"B7","first-page":"109","article-title":"Complications of deep nonpenetrating sclerectomy","volume":"68","author":"Strnad","year":"2012","journal-title":"Cesk Slov Oftalmol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1097\/IJG.0000000000000437","article-title":"Mid-term clinical results of CO[[sb]]2[[\/s]] laser-assisted sclerectomy surgery (CLASS) for open-angle glaucoma treatment","volume":"25","author":"Geffen","year":"2016","journal-title":"J Glaucoma."},{"key":"B9","doi-asserted-by":"publisher","first-page":"e582","DOI":"10.1111\/aos.13718","article-title":"CO2 laser-assisted sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma. A 1-year follow-up","volume":"96","author":"Jankowska-Szmul","year":"2018","journal-title":"Acta ophthalmol."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1445","DOI":"10.1007\/s10792-021-01707-2","article-title":"Evaluating CO2 laser-assisted sclerectomy surgery with mitomycin C combined with or without phacoemulsification in adult Asian glaucoma subjects","volume":"41","author":"Ho","year":"2021","journal-title":"Int ophthalmol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"6639583","DOI":"10.1155\/2021\/6639583","article-title":"CO2 laser-assisted deep sclerectomy surgery compared with trabeculectomy in primary open-angle glaucoma: two-year results","volume":"2021","author":"Zhang","year":"2021","journal-title":"J ophthalmol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"418","DOI":"10.5935\/0004-2749.202100111","article-title":"Reply: efficacy and safety of CO2 laser-assisted sclerectomy surgery for glaucoma: a systematic review and meta-analysis","volume":"84","author":"Dai","year":"2021","journal-title":"Arq Bras Oftalmol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"e630","DOI":"10.1097\/IJG.0000000000000187","article-title":"Results of CO2 laser-assisted deep sclerectomy as compared with conventional deep sclerectomy","volume":"25","author":"Greifner","year":"2016","journal-title":"J Glaucoma."},{"key":"B14","doi-asserted-by":"publisher","first-page":"2283","DOI":"10.1038\/s41433-020-01235-w","article-title":"Surgical site characteristics after CLASS followed by ultrasound biomicroscopy and clinical grading scale: a 2-year follow-up","volume":"35","author":"Yan","year":"2021","journal-title":"Eye."},{"key":"B15","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1159\/000334781","article-title":"Laser-assisted techniques for penetrating and nonpenetrating glaucoma surgery","volume":"50","author":"Geffen","year":"2012","journal-title":"Dev Ophthalmol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1007\/s00417-006-0413-4","article-title":"Experimental studies on nonpenetrating filtration surgery using the CO2 laser","volume":"245","author":"Assia","year":"2007","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B17","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1007\/s00417-017-3844-1","article-title":"Prospective evaluation of CO2 laser-assisted sclerectomy surgery (CLASS) with Mitomycin C","volume":"256","author":"Cutolo","year":"2018","journal-title":"Graefes Arch Clin Exp Ophthalmol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"367","DOI":"10.1097\/IJG.0000000000001460","article-title":"Modified CO2 laser-assisted sclerectomy surgery in Chinese patients with primary open-angle glaucoma and pseudoexfoliative glaucoma: A 2-year follow-up study","volume":"29","author":"Zhang","year":"2020","journal-title":"J Glaucoma"},{"key":"B19","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1016\/j.ajo.2015.06.002","article-title":"Association of ocular conditions with narrow angles in different ethnicities","volume":"160","author":"Lee","year":"2015","journal-title":"Am J Ophthalmol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"578","DOI":"10.1097\/IJG.0b013e3181996f19","article-title":"High prevalence of narrow angles among Chinese-American glaucoma and glaucoma suspect patients","volume":"18","author":"Seider","year":"2009","journal-title":"J Glaucoma"},{"key":"B21","doi-asserted-by":"publisher","first-page":"311","DOI":"10.1016\/S0002-9394(01)01028-5","article-title":"The Advanced Glaucoma Intervention Study (AGIS): 9. Comparison of glaucoma outcomes in black and white patients within treatment groups","volume":"132","author":"Investigators","year":"2001","journal-title":"Am J Ophthalmol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1111\/j.1755-3768.2014.T047.x","article-title":"Bleb needling outcomes for failed trabeculectomy blebs in Asian eyes: a 2-year follow up","volume":"8","author":"Tsai","year":"2015","journal-title":"Int J Ophthalmol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/IJG.0b013e3181f7b14f","article-title":"CO2 laser-assisted sclerectomy surgery part I: concept and experimental models","volume":"21","author":"Ton","year":"2012","journal-title":"J Glaucoma"},{"key":"B24","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1097\/IJG.0000000000001104","article-title":"Outcomes of laser goniopuncture following nonpenetrating deep sclerectomy with mitomycin C: a large retrospective cohort study","volume":"28","author":"Penaud","year":"2019","journal-title":"J Glaucoma"},{"key":"B25","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1097\/00061198-200206000-00009","article-title":"Deep sclerectomy with collagen implant in one eye compared with trabeculectomy in the other eye of the same patient","volume":"11","author":"Ambresin","year":"2002","journal-title":"J Glaucoma."},{"key":"B26","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.sjopt.2014.09.015","article-title":"Incidence, efficacy and safety of YAG laser goniopuncture following nonpenetrating deep sclerectomy at a university hospital in Riyadh, Saudi Arabia","volume":"29","author":"Al Obeidan","year":"2015","journal-title":"Saudi J Ophthalmol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"93","DOI":"10.17116\/oftalma201913502193","article-title":"Nd:YAG laser goniopuncture as a mandatory adjuvant procedure after non-penetrating deep sclerectomy (long-term observation results)","volume":"135","author":"Volkova","year":"2019","journal-title":"Vestn Oftalmol."}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.806734\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,24]],"date-time":"2021-12-24T09:08:24Z","timestamp":1640336904000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2021.806734\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,24]]},"references-count":27,"alternative-id":["10.3389\/fmed.2021.806734"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2021.806734","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,24]]},"article-number":"806734"}}