Abstract
ImportanceTo investigate the safety, effectiveness and follow‐up rates after transscleral diode laser cyclophotocoagulation as primary treatment for seeing eyes with primary open angle glaucoma in Bauchi, Nigeria.BackgroundThere is a high prevalence of primary open angle glaucoma in Africa where adherence to medical treatment and acceptance of surgery are poor.DesignProspective case series.ParticipantsNew glaucoma patients where surgical intervention was recommended.MethodsA diode 810 nm laser G‐probe was used under retrobulbar anaesthesia to deliver approximately 20 shots for 2000 ms, titrating the power. If both eyes were treated the first was the study eye. Repeat treatment offered if the intraocular pressure (IOP) was >21 mmHg on two consecutive visits.Main Outcome MeasuresIOP < 22 mmHg, change in ≥2 lines of Snellen visual acuity (VA), and complications.Results201 out of 204 eyes with complete data analysed. Mean age 52 years, 17 (8.3%) eyes were re‐treated. Mean pre‐treatment IOP was 39 (SD 11) mmHg. 106 (53%) attended at 12 months when the mean IOP was 19 (7–45) mmHg; 77 (73%) had IOP < 22 mmHg. VAs were better in 13 (12.3%) and worse in 23 (21.7%) eyes. Postoperative complications included mild uveitis (5.5%), corneal oedema (2.5%), severe uveitis (0.5%) and transient hypotony (2.0%). No hypotony at 12 months.Conclusions and RelevanceTransscleral diode laser cyclophotocoagulation controlled IOP in almost three quarters of eyes at 12 months with short‐term preservation of vision and minimal complications. Poor follow‐up in this setting highlights the need for an effective, safe and acceptable treatment where regular follow‐up is less critical.
Highlights
Africa is the region with the highest prevalence of primary open angle glaucoma (POAG)affecting an estimated 7 million people aged 40-80 years.[1]
There are only a few studies comparing outcomes of surgical interventions for glaucoma in patients of African descent, including laser procedures.[26,27] In a recent review, the authors concluded that there was no evidence that any procedures are superior to trabeculectomy, and there is compelling evidence that the outcomes of trabeculectomy are less good than for Caucasian eyes, if antimetabolites are not used.[28]. Given the relatively low uptake of surgery, poor outcomes and inadequate follow-up, laser treatment could be considered as a primary treatment for glaucoma in Africa despite the limited reported evidence
In another UK study, 49 seeing eyes were treated for uncontrolled glaucoma and at five years intraocular pressure (IOP) was controlled (6-21mmHg) in 79.6% of eyes; 30.6% lost ≥2 lines of visual acuity (VA).[31]. Primary transscleral diode laser cyclophotocoagulation as (TDLC) treatment has been reported in several studies (Table 1 and 2, see Appendix)
Summary
Africa is the region with the highest prevalence of primary open angle glaucoma (POAG)affecting an estimated 7 million people aged 40-80 years.[1]. At 2 years 80% of eyes had an IOP of
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