Ab Interno Sclerostomy With a High-Powered Argon Endolaser

A high-powered argon blue-green laser coupled to a 300-microns quartz fiberoptic probe was used to create an ab interno sclerostomy in a patient undergoing enucleation for a blind painful eye. Despite the presence of diffuse rubeosis, 360 degrees peripheral anterior synechiae, and superior conjunctival scarring, it was possible to create a full-thickness defect from the anterior chamber angle to the subconjunctival space without operative complications. Six laser applications were required using 8 W of power per pulse and 0.1-second pulse duration. The eye was enucleated immediately after the laser procedure, prepared for light microscopy, and sectioned serially. Histologic analysis demonstrated a patent fistula approximately 300 microns in diameter with sharp wound margins. Tissue damage was localized to within 150 microns of the sclerostomy. The overlying conjunctiva was intact.