Abstract
Objectives:To evaluate the efficacy and safety of transscleral cyclophotocoagulation (TS-CPC) limited to 180° of ciliary body ablation in patients with various forms of refractory glaucoma.Materials and Methods:Thirty eyes with refractory glaucoma treated with 180° TS-CPC were retrospectively analyzed for intraocular pressure (IOP) reduction and success rates. Patients’ age, gender, type of glaucoma, number of diode laser treatment sessions, postoperative complications, number of hypotensive medications required to control IOP, and best corrected visual acuity (BCVA) were evaluated. The criteria for success were defined as postoperative IOP <21 mmHg or >20% decrease in IOP with or without additional medical treatment.Results:The mean age of all patients was 51.3±26.9 years (range,1-84 years). The mean postoperative IOP level (23.9±8.5 mmHg) was significantly lower than preoperative IOP (39.2±8.9 mmHg) (p<0.001). The success rate was 66.6% after the first laser treatment and reached 86.7% following repeat laser treatments over an average follow-up period of 22.2±19.9 months. The need for topical hypotensive medications decreased from 2.8±1.0 preoperatively to 2.4±1.3 following TS-CPC (p=0.048). Two patients (6.6%) had a one-line decrease in their BCVA following TS-CPC. Transient hypotony and hyphema developed in 4 patients (13.3%). Total laser energy delivered did not correlate with either preoperative (rho=0.10; p=0.594) or postoperative IOP (rho=0.21; p=0.260).Conclusion:TS-CPC limited to 180° of ciliary body ablation is associated with a reasonable success rate and low incidence of adverse effects in patients with refractory glaucoma.
Highlights
Destruction of the ciliary body using various methods is an option for the management of refractory glaucoma when conventional medical and or surgical modalities fail to adequately control intraocular pressure (IOP).[1,2,3] Transscleral cyclophotocoagulation (TS-CPC) is currently a widely employed method of ciliary body ablation that reduces aqueous humor formation by destroying the ciliary body and ciliary epithelium using a continuous diode laser energy source.[4]
The extent of response to transscleral cyclophotocoagulation (TS-CPC) differs depending on the underlying glaucoma, with higher success rates attained in primary open-angle glaucoma (POAG), neovascular glaucoma (NVG), and inflammatory glaucomas compared with congenital, juvenile, and traumatic
The findings of the current study reveal that limiting the extent of laser treatment to 180 degrees is associated with a low incidence of adverse effects and appears to be relatively safe, with about 67% of eyes achieving satisfactory IOP lowering after a single treatment session
Summary
Destruction of the ciliary body using various methods is an option for the management of refractory glaucoma when conventional medical and or surgical modalities fail to adequately control intraocular pressure (IOP).[1,2,3] Transscleral cyclophotocoagulation (TS-CPC) is currently a widely employed method of ciliary body ablation that reduces aqueous humor formation by destroying the ciliary body and ciliary epithelium using a continuous diode laser energy source.[4] In its most common form, TS-CPC employs an 810 nm semiconductor diode laser, the energy of which has been shown to be absorbed by melanin in the ciliary epithelium. Reported IOP reduction for this procedure has varied between 12% and 66% in different studies.[1,2,7,8] The extent of response to TS-CPC differs depending on the underlying glaucoma, with higher success rates attained in primary open-angle glaucoma (POAG), neovascular glaucoma (NVG), and inflammatory glaucomas compared with congenital, juvenile, and traumatic
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