The repair response following Nd:YAG laser sclerostomy Ab interno in rabbits

This study was undertaken to examine ultrastructurally the course of tissue regeneration after thermally-induced laser sclerostomy and compare it with the post-operative clinical events in a rabbit model. Applying a continuous wave neodymium:YAG (Nd:YAG) laser, two sclerostomies were created ab interno on one eye in each of ten pigmented rabbits using a 200- μ m-diameter quartz optical fiber; the unoperated fellow-eyes served as controls. Intraocular pressure (IOP) was measured daily before and after surgery. Animals were observed post-operatively for up to 16 days. Well-defined filtering blebs and a low complication rate demonstrated the success of the procedure. IOP was significantly lowered during the entire course of the observation period but after the fifth day, the conjunctival blebs had disappeared. The morphology of the changes in the sclerostomy fistulas were analysed at 2-day intervals by light and electron microscopy. Immediately after surgery, the canal was ensheathed by an approximately 100- μ m-thick layer of coagulated collagenous tissue in which two zones could be distinguished according to the intensity of damage. Within 5 days, the inner and outer canal openings were invaded by macrophages and fibroblasts originating from the iris root and episclera, respectively. The former cells were engaged in the phagocytosis of disintegrated collagen adjacent to the lumen. More distally located fibrils which had incurred less severe damage, had retained their fibrillar structure but had lost banding periodicity. After thermal stress had faded, they appeared to undergo a process of repolymerisation. By day 10, the lumen had become occluded by a loose meshwork of phagocytes, fibroblasts and proliferating capillaries. These new vessels and the loose nature of the canal-occluding framework and of the surrounding regenerating collagenous tissue could have further permitted percolation and transport of aqueous humor, since IOP remained low, despite the disappearance of filtering blebs. Although the time course of repair is more rapid in rabbits than in humans, the data gleaned nonetheless yield valid information respecting the sequence of events following thermally-induced scleral fistula.