MULTICENTER CLINICAL-EXPERIENCE USING AN ERBIUM-YAG LASER FOR VITREORETINAL SURGERY

Purpose: To evaluate the advantages, disadvantages, safety, complicati ons, and surgical applicability of an erbium:YAG laser system for mane uvers in vitreoretinal surgery. Methods: A prospective, consecutive tr ial of 68 eyes in 66 patients undergoing vitreoretinal surgery in whic h an erbium:YAG laser with graduated output from 0.2 to 5.0 mJ per pul se, repetition rate of 2 to 30 Hz, and equipped with a flexible fiber optic and interchangeable 20-gauge intraocular fiber optic endoprobes was used to perform specific maneuvers, including transection, incisio n, and ablation of membranes, retinotomy, vessel coagulation, iridecto my, and lens tissue ablation. The patients were treated in five center s in contemporary vitreoretinal surgical settings for surgical indicat ions, including proliferative diabetic retinopathy, proliferative vitr eoretinopathy, epiretinal membrane, and retinopathy of prematurity. Re sults: One hundred seventy-four maneuvers were performed with an overa ll surgical efficacy rating of excellent or good in 84% of maneuvers, ranging from a high of 100% for subretinal membrane transection to a l ow of 25% for coagulation of blood vessels. Complications included ret inal break or photocoagulative injury in 5% of epiretinal membrane inc isions, minor bleeding from transected retinal vessels during 29% of r etinotomies, and intraocular lens damage during two posterior capsulot omies. The most significant limitation was the cautious pace used duri ng maneuvers near the retinal surface. Conclusion: The erbium:YAG lase r is capable of versatile new approaches offering precise tissue cutti ng and ablation in vitreoretinal surgical maneuvers with a high degree of safety. The main limitation encountered was the slow speed of cert ain critical maneuvers near the retina.