Glaucoma management and future perspective

We have asked a few questions to Prof. Shlomo Melamed of Tel Aviv University to understand the state of the art and the future perspectives in glaucoma management. For his professional expertise he can be for us an excellent guide to the latest technological and scientific developments.

We can start our interview with your opinion about the importance of technological research.
No doubt that technological research and development are essential for improved diagnosis and treatment of Glaucoma.

Could you explain to our readers the recent applications of the use of laser in penetrating and nonpenetrating glaucoma surgery?
I am actively involved in the development and evaluation of the CO2 laser Sclerectomy which is a minimally invasive procedure aimed at the un-roofing of Schlemm’s canal ab-externo. This may fit into your definition of “Non-Penetrating” surgery, although I don’t think we should use this term, as all of our procedures are somehow “penetrating”.
There were several attempts in the past to use various lasers for full-thickness filtration surgery. We tried the Flash-Lamp Pulsed Dye Laser for creating a sclerectomy Ab-Interno after staining the Trabeculum with Methylene Blue, but the hypotensive effect was short lived. Holmium Laser and even Excimer laser (by Prof. Carlo Traverso) were used as well, but due to practical issues as well as complications related to full-thickness surgery – all of them have not materialized into routine procedures for Glaucoma.

Do you think that surgical expertise will maintain a central importance with the development of more and more precise lasers?
It is a hard question. On one hand, refining lasers and improved precision of laser systems will enhance our abilities to be more accurate while focusing on miniature structures (such as Schlemm’s Canal). However, the more advanced tools we shall have, we shall dare more by aiming at targets which have been out of the scope of our abilities to treat, and this may require additional surgical expertise.


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Dr. Carmelo Chines
Direttore responsabile