INITIAL CLINICAL-EXPERIENCE WITH AN ERBIUM-YAG LASER FOR VITREORETINAL SURGERY

PURPOSE: We tested the efficacy of an erbium:YAG laser for maneuvers i n patients undergoing vitreoretinal surgery. METHODS: An erbium:YAG la ser equipped with a flexible fiberoptic and interchangeable 20-gauge e ndoprobes of various tip configurations ranging from 100 to 365 mu m w as used for specific maneuvers in 13 patients referred for vitreoretin al surgery for diabetic traction detachment, proliferative vitreoretin opathy, retinal detachment with posterior break, and epimacular membra ne. The following maneuvers were performed: (1) transection of elevate d vitreous membranes, (2) incision of epiretinal membranes, (3) draina ge and relaxing retinotomy, (4) transection of subretinal membranes, ( 5) noncontact ablation of epiretinal membranes in air-filled eyes, (6) ablation of lens remnants, (7) posterior capsulotomy, (8) iris surger y, and (9) retinal vascular coagulation. RESULTS: Forty-eight defined maneuvers were performed with energy levels ranging from 0.2 to 5.0 mJ and repetition rates of 2 to 30 Hz. Transection of elevated membranes , subretinal membranes, and retinotomies were easily performed. Fourte en incisions into vascularized epiretinal membranes in diabetic tracti on detachment surgery demonstrated a fine margin of coagulation that p ermitted hemostatic incision, Retinal breaks were created during one o f these incisions. Lens remnant ablation, posterior capsulotomy, and i ris tissue removal were successful, with a single complication consist ing of damage to the posterior surface of an intraocular lens during a pars plana posterior capsulotomy accomplished by means of a side-firi ng probe, Epiretinal membrane ablations in air-filled eyes were effect ively performed in a gradual fashion without hemorrhage. CONCLUSIONS: The erbium:YAG laser offers precise and effective tissue cutting and r emoval in vitreoretinal maneuvers. Further study will deter mine the r ole of this technology in vitreoretinal surgery.