Transscleral cyclophotocoagulation followed by cataract surgery: a novel protocol to treat refractory acute primary angle closure

Wei Liu,Nomdo M Jansonius,Dandan Huang,Jian Ji,Ruru Guo,Luning Qin,Chenjia Xu

doi:10.1186/s12886-020-01483-0

Abstract

BackgroundTo introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery.MethodsThirteen APAC eyes (13 patients) were enrolled in this prospective case series as study group. All patients underwent emergency TCP (20 pulses of 2000 mW during 2000 ms applied to the inferior quadrant) followed by scheduled cataract surgery. They were compared to 13 age- and gender-matched patients treated with emergency phacotrabeculectomy. We recorded intraocular pressure (IOP), best corrected visual acuity (BCVA), and complications, and several ultrasound biomicroscopy (UBM) parameters before and after TCP.ResultsIn the study group, IOP decreased from 51.5 ± 7.0 mmHg (mean ± standard deviation) before TCP to 16.4 ± 5.4 mmHg 1 day after TCP (P < 0.001). At 6 months, there was no significant difference in IOP between the study group (14.0 ± 3.4 mmHg) and control group (16.7 ± 4.3 mmHg; P = 0.090); IOP lowering medications were used by 0/13 in the study group and 2/13 patients in the control group (P = 0.48). At 6 months, there was no significant difference in BCVA between the study group and the control group (20/25 (20/200 to 20/25) and 20/30 (20/50 to 20/25), respectively; P = 1.0). The UBM parameters anterior chamber depth (P = 0.016), angle-opening distance at 500 μm (P = 0.011), and maximum ciliary body thickness (P < 0.001) increased significantly while the iris-ciliary process distance decreased significantly (P = 0.020) after TCP.ConclusionsTCP effectively lowers IOP and modifies the anterior chamber morphology in APAC; TCP followed by cataract surgery can be considered an alternative to treat refractory APAC but needs further evaluation.Trial registrationThis project was registered in Chinese Clinical Trial Registry (ChiCTR1800017475) at July, 31, 2018 (http://www.chictr.org.cn/edit.aspx?pid=29629&htm=4).

Highlights

To introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery
We aimed to evaluate the safety and efficacy of TCP followed by cataract surgery on treating APAC
All patients presented with typical APAC symptoms and signs, including blurred vision, severe ocular pain, headache, nausea, vomiting, corneal edema, unresponsive dilated pupil, shallow anterior chamber, and elevated intraocular pressure (IOP)

Summary

Introduction

To introduce a novel protocol to treat refractory acute primary angle closure (APAC): transscleral cyclophotocoagulation (TCP) followed by cataract surgery. The current treatment strategy for APAC is to lower IOP by both topical and systemic medications followed by laser peripheral iridoplasty or iridotomy, and removal of the lens. The IOP of a significant proportion of APAC eyes cannot be controlled successfully by medical treatment, while laser application is often limited by corneal edema [3]. Performing acute surgery on APAC eyes is technically challenging and may increase the risk of complications because of the presence of corneal edema, inflammation, shallow anterior chamber, floppy iris and unstable lens [3]

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