Abstract
Purpose To examine the surgical outcomes and graft conditions in patients receiving micropulse transscleral cyclophotocoagulation (MP-TSCPC) to treat post-keratoplasty ocular hypertension. Methods This retrospective observational study included 30 eyes of 28 consecutive glaucoma patients with a history of penetrating keratoplasty (PKP) or Descemet's stripping automated endothelial keratoplasty (DSAEK) who underwent MP-TSCPC at the University of California, San Francisco from 09/2015 to 08/2018. Using the Wilcoxon signed-rank test, we compared preoperative and postoperative intraocular pressure (IOP), number of glaucoma medications, visual acuity, and central corneal thickness at 1, 3, 6, and 12 months. Postoperative complications, additional surgeries, and graft failures were also recorded at these follow-up times. Linear regression model was used to study whether PKP vs. DSAEK affects the effectiveness of MP-TSCPC. Results Thirty eyes from 28 patients were followed for 12 months. IOP was significantly decreased from preop at all follow-up points (P < 0.001). There was no significant change in the number of glaucoma drops, visual acuity, or CCT. At 12 months, 21 of the 30 eyes met the definition of success, and only one underwent repeat PKP due to graft rejection. The type of corneal transplant was not a significant factor for IOP reduction at the last follow-up. Conclusions MP-TSCPC achieved desirable IOP control and success rates for postkeratoplasty patients while resulting in minimal complications and graft failure. It appears to be a safe and effective procedure in patients who received corneal transplant with one-year follow-up.
Highlights
Jun Hui Lee,1 Vivian Vu,2 Gabriel Lazcano-Gomez,3 Katherine Han,3 Pukkapol Suvannachart,3 Jennifer Rose-Nussbaumer,3 Julie Schallhorn,3 David Hwang,3 and Ying Han 3
intraocular pressure (IOP) was significantly decreased from preop at all follow-up points (P < 0.001). ere was no significant change in the number of glaucoma drops, visual acuity, or central corneal thickness (CCT)
73.3% had a history of cataract surgery, 46.3% had a history of previous glaucoma surgery, and 50% had a history of repeat corneal transplant. e median time between the last corneal transplant and the MPTSCPC treatment was 15.2 months
Summary
Jun Hui Lee, Vivian Vu, Gabriel Lazcano-Gomez, Katherine Han, Pukkapol Suvannachart, Jennifer Rose-Nussbaumer, Julie Schallhorn, David Hwang, and Ying Han 3. MP-TSCPC achieved desirable IOP control and success rates for postkeratoplasty patients while resulting in minimal complications and graft failure. It appears to be a safe and effective procedure in patients who received corneal transplant with one-year follow-up. Previous studies showed that it offers satisfactory IOP control with less complications compared to the continuous wave TSCPC [15,16,17,18] It does not require an incision or tube placement and does not risk disrupting the intraocular flow that may damage the corneal endothelium. Along with demographic and clinical characteristics, the following parameters were recorded for each patient: preoperative and postoperative IOP by pneumatonometry, number of glaucoma medications, visual acuity, central corneal thickness (CCT), and postoperative complications at 1 month, 3 months, 6 months, and 12 months of follow-up. Statistical calculations were performed with SPSS (IBM SPSS Statistics 22.0) with P < 0.05, before Bonferroni correction, denoting the statistical significance of differences
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