Ocular integrity after anterior ciliary sclerotomy and scleral ablation by the Er:YAG laser

PURPOSE: To establish the risk of ocular rupture after proposed surgical reversal of presbyopia by anterior ciliary sclerotomy (ACS) or by the Er:YAG laser (HOYA Continuum, Tokyo, Japan). METHODS: A total of 45 pig eyes (15 control eyes) were examined. Fifteen eyes were placed into one of two study groups and another 15 eyes were used as controls. One group underwent scleral incisions with the use of a diamond knife, and the other group underwent Er:YAG laser scleral incisions. In both study groups, 8 radial incisions, 2 parallel cuts each at 4 quadrants, 2 mm apart, 4 mm long, and starting 2 mm away from the limbus, were made. A 3-kg steel weight was released from a measured height to the pig's eye, and ocular rupture energy (joules) was measured. RESULTS: The mean rupture energy was 26.0 J for control eyes, 15.7 J for the ACS eyes, and 12.2 J for the Er:YAG laser eyes. The ACS and the Er:YAG laser eyes ruptured at significantly lower energies (ACS, P<.001; Er:YAG, P<.001) than the control eyes. Comparison of the ACS group and the Er:YAG laser group showed no statistically significant difference (P=.052) in rupture energy. CONCLUSIONS: Scleral incisions by ACS and the Er:YAG laser significantly weakened ocular integrity compared with control eyes. Any patients undergoing ACS or Er:YAG laser scleral incision should be informed of the attendant potential risk after ocular trauma.