Abstract
To evaluate the effectiveness in in-traocular pressure reduction and safety of micropulse trans-scleral diode cyclophotocoagulation in refractory glaucoma. We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of ≥2 lines of vision on the Snellen chart or a ≥2-level decrease in visual function in patients with nonmeasurable chart acuity. The mean age was 61.04 ± 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 ± 15.95 mmHg, and the mean number of medications was 3.5 ± 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% ± 29.72% in the first week and 41.59% ± 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 ± 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%). Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication.
Highlights
Glaucoma is the leading cause of irreversible blindness in the world, with approximately 8.4 million people blind from glaucoma[1,2]
Given the potential risk of sight-threatening complications coupled with the unpredictability of the intraocular pressure (IOP)-lowering effect, transscleral laser diode cyclophotocoagulation (TSCPC) has been used after clinical treatment or invasive procedu res have failed[10,11,12,13]
One patient with neovascular glaucoma (NVG) sho wed 0 mmHg IOP on postoperative day 30 and was treated with atropine 1% and prednisolone 1% eye drops for 1 month, later presenting with IOPs between 9 and Authors Tan et al, 2010(15)
Summary
This prospective interventional study conducted at the University of Campinas (UNICAMP), Campinas, São Paulo, Brazil, was approved by the Ethics Committee of the University of Campinas. The protocol was in com pliance with Good Clinical Practices and the tenets of the Declaration of Helsinki (1996)
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