Abstract
BackgroundThe primary goal of glaucoma treatment is to lower and control intraocular pressure (IOP) and thereby prevent functional deterioration. For glaucomas that are refractory to medical and incisional surgical therapies, transscleral diode cyclophotocoagulation (TCP) is a well-established procedure to effectively decrease IOP. This study investigated rates of visual field (VF) change in patients with glaucoma before and after TCP.MethodsThis retrospective case series investigated rates of VF changes in glaucoma patients before and after they underwent TCP. At least four VF examinations were required, two before and two after surgery. VF examinations were performed using standard automated perimetry and rates of change were calculated by linear regression analysis of mean deviation (MD) values measured over time.ResultsA total of 46 eyes of 43 patients were included and followed on average 3.6 years before and 2.1 years after TCP. 67 % of the eyes showed further progression of glaucoma following surgery. Mean preoperative MD change was −0.21 dB/year (SE = 0.08, 95 % CI [−0.06, −0.37]). Postoperatively the mean change was −0.26 dB/year (SE = 0.22 95 % CI [0.38, −0.48]) which results in a difference between pre- and postoperative MD rate of 0.05 dB/year (p = 0.824). The mean MD value was worse after surgery and dropped by 1.73 dB (SE = 0.58, 95 % CI [−0.59, −2.87], p = 0.003). Intraocular pressure (IOP) decreased from 23.2 mmHg (SD = 4.67) before TCP to 14.3 mmHg (SD = 3.17) after TCP (p < 0.001). For each 1 mmHg of IOP reduction after surgery, postoperative rate of VF loss decreased by 0.15 dB/year.ConclusionRates of glaucomatous visual field loss did not significantly change after TCP and the majority of the eyes showed further progression of glaucoma after surgery. Mean MD value was considerably lower after TCP.
Highlights
The primary goal of glaucoma treatment is to lower and control intraocular pressure (IOP) and thereby prevent functional deterioration
After transscleral diode cyclophotocoagulation (TCP), average IOP in the analysed subgroup of 39 eyes was reduced by 8.9 mmHg (p< 0.001, SD = 4.47), which corresponds to a relative reduction of 38 %
After TCP the mean progression rate was −0.26 dB/year (SE = 0.22, 95 % CI [0.38, −0.48]) which results in a difference between pre- and postoperative mean deviation (MD) change of 0.05 dB/ year (p = 0.8235)
Summary
The primary goal of glaucoma treatment is to lower and control intraocular pressure (IOP) and thereby prevent functional deterioration. For glaucomas that are refractory to medical and incisional surgical therapies, transscleral diode cyclophotocoagulation (TCP) is a well-established procedure to effectively decrease IOP. This study investigated rates of visual field (VF) change in patients with glaucoma before and after TCP. The primary goal of glaucoma treatment is to effectively lower and control IOP and thereby prevent functional deterioration. This can either be achieved with medical therapy, incisional surgery or cyclodestructive methods such as TCP. The purpose of the current study is to compare the rates of change in the VF before and after TCP in patients with difficult to manage glaucoma
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