Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation

Markus Lenzhofer,Wolfgang Hitzl,Herbert A Reitsamer,Armin Motaabbed,Hans Peter Colvin,Veit Steiner,Sarah Moussa,Karolina Motloch,Melchior Hohensinn

doi:10.1007/s00417-021-05157-5

Abstract

PurposeTransscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population.MethodsRetrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP.ResultsIOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months.ConclusionThe present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.

Highlights

Glaucoma is one of the leading causes of irreversible blindness in the world
The present study demonstrates a mid-term intraocular pressure (IOP)-lowering effect after COCO, while reducing the burden for topical and systemic IOP-lowering medications
A chart review collected data of the first two postoperative years: the baseline demographic data included the type of glaucoma and PEX status, postoperative IOP assessed by single Goldmann Applanation tonometry measurements in all patients, number of topical and systemic IOP-lowering medications, mean deviation of the visual field (MDVF, SITA standard 30-2, HFA II, Humphrey Instruments, USA), best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI, if applicable) were recorded

Summary

Introduction

Much effort has been made to develop surgical techniques for lowering intraocular pressure (IOP) to treat glaucoma [1,2,3,4,5]. Aqueous outflow obstruction is the main cause of IOP elevation, which can be mitigated either by increasing outflow or reducing aqueous humor production [6]. Cyclodestructive procedures target and destroy the ciliary body epithelium to lower intraocular pressure by reducing aqueous humor inflow into the eye [6]. The most commonly used approach is transscleral laser cyclophotocoagulation (tCPC) [6], as first described by Beckman in 1972 [11, 12] It can be performed using neodymium:yttriumaluminum-garnet (Nd:YAG) or a diode laser [13, 14]. The evidence is still inconclusive as to which type of cyclodestructive procedure is superior [10, 15]

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