Transscleral Cyclophotocoagulation Research Articles

The efficacy and safety of micropulse transscleral laser treatment in glaucoma: a systematic review and meta-analysis

ObjectiveMicropulse transscleral laser treatment (mTLT) is the latest alternative intraocular pressure (IOP) lowering approach for glaucoma patients. This meta-analysis aims to evaluate the efficacy and safety of mTLT and continuous wave transscleral cyclophotocoagulation (CW-TSCPC) for the treatment of glaucoma.MethodsWe searched the PubMed, Embase, and Cochrane Library of Systematic Reviews databases from January 2000 to July 2022 to identify studies that, evaluated the efficacy and safety of mTLT in glaucoma. There were no restrictions regarding study type, patient age, or type of glaucoma. We analysed the reduction in IOP and the number of anti-glaucoma medications (NOAM), retreatment rates, and complications between mTLT and CW-TSCPC treatment. Publication bias was conducted for evaluating bias. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2020) reporting guideline.ResultsWe identified 6 eligible studies of which only 2 RCTs and 386 participants with various types of glaucoma at different stages were ultimately included. The results revealed significant IOP decreases after mTLT up to 12 months and significant NOAM reductions at 1 month (WMD=-0.30, 95% CI -0.54 to 0.06), and 3 months (WMD=-0.39, 95% CI -0.64 to 0.14) in mTLT compared to CW-TSCPC. Moreover, the retreatment rates (Log OR=-1.00, 95% CI -1.71 to -0.28), hypotony (Log OR=-1.21, 95% CI -2.26 to -0.16), prolonged inflammation or uveitis (Log OR=-1.63, 95% CI -2.85 to -0.41), and worsening of visual acuity (Log OR=-1.13, 95% CI -2.19 to 0.06) occurred less frequently after mTLT.ConclusionOur results demonstrated that mTLT could lower the IOP until 12 months after treatment. mTLT seems to have a lower risk of retreatment after the first procedure, and mTLT is superior to CW-TSCPC with respect to safety. Studies with longer follow-up durations and larger sample sizes are necessary in the future.Trial registration numberINPLASY202290120.

Транссклеральная диод-лазерная циклофотокоагуляция в микроимпульсном режиме у пациентов с рефрактерной глаукомой

The aim of the work was to study clinical efficacy of micropulsed transscleral diode laser cyclophotocoagulation (MTDСFC) in patients with refractory glaucoma. Material and methods. After careful standard ophthalmologic eye examination, 60 patients underwent mTDGFC to compensate the intraocular pressure (IOP) and stabilize the visual and functional indices. Results. Immediately on the next day after the procedure a brightening of the cornea and a decrease of the degree of perilymphalic congestion were observed. IOP level decreased from 42.0 ± 1.2 to 20.97 ± 1.12 in 47.6% of cases, and in a year – to 18.85 ± 0.7. In 40% of cases (n = 24) the visual acuity improved from 0.03 ± 0.01 to 0.06 ± 0.05 which was statistically significant (p < 0,05). In 16.7% of cases (n = 10) there was an increase in the visual field boundaries by an average of 5 degrees. In 15 eyes (25.0%) it became possible to observe fundus. An important advantage of mTDFC was a 52.4% decrease in the number of hypotensive drugs used by the end of follow-up: from 3.0 ± 0.5 to 1.0 ± 0.5 drugs (p < 0.05). In the early postoperative period subconjunctival hemorrhages in 5 (8.3%) patients, hyphema 1 mm in 1 (1,7%) patient were among the available complications; they dissolved after hematase and dexamethasone injection. Conclusions. mTDFC should be performed in patients at earlier stages of refractory glaucoma, providing compensation for varying degrees of elevated IOP. This procedure contributes to the elimination or significant reduction of pain syndrome, which preserves eye function, improves patients'quality of life, and is an alternative to laser treatment of refractory glaucoma. Keywords: refractory glaucoma, surgical treatment, laser cyclophotocoagulation, micropulse cyclophotocoagulation, transscleral cyclophotocoagulation

Cyclophotocoagulation - current applications and practical aspects

Despite the advent of a large variety of minimally invasive glaucoma surgery (MIGS) techniques cyclophotocoagulation (CPC) remains a popular treatment option to lower intraocular pressure (IOP) in glaucoma patients. Guidelines for glaucoma treatment point to the rather unphysiological mode of action and, thus, recommend CPC mainly for refractory glaucoma and/or eyes with limited visual potential. The primary target of CPC is the pigmented secretory ciliary body epithelium resulting in a decreased production of aqueous humor. In addition, an increase of aqueous outflow may contribute to the IOP lowering. CPC is generally considered a low risk intervention. However, macular edema, prolonged intraocular inflammation, vision loss, hypotony, pain or phthisis occur at considerable rates. Over the past decades new promising modes of cyclophotocoagulation have evolved aiming at reducing the risk of adverse effects and improving the efficiency. This article provides an overview of the different currently available cyclophotocoagulation modes: Besides the classic transscleral continuous-wave cyclophotocoagulation it covers endoscopic cyclophotocoagulation, micropulse transscleral laser treatment and transscleral controlled cyclophotocoagulation. Various practical aspects of the treatment in light of the current literature are being discussed.

Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes.

This study evaluates the safety and efficacy of micropulse transscleral cyclophotocoagulation (MPTSCPC) in glaucoma patients, with standard parameters, over a 24-month period. Retrospective analysis of 61 eyes undergoing MPTSCPC from January 2018 to December 2020 was carried out. Patients received 160 seconds of laser, with settings of 2000 mW/cm2 and a duty cycle of 31.3%. A total of 61 eyes were included, arranged in an age distribution of 73.9 ± 10.8 years. The most frequent diagnosis was primary open-angle glaucoma (POAG), with a mean best-corrected visual acuity (BCVA) of 5/10 in the Snellen Visual chart. Around 37.7% of the eyes had undergone at least one glaucoma filtration surgery prior to MPTSCPC. The mean pretreatment intraocular pressure (IOP) was 24.9 ± 8.6 mm Hg. Except for the contrast at 24 months, at every other follow-up visit, there was a significant reduction (p ≤ 0.001) in IOP and in the number of topical drugs required to control IOP, from four (baseline) to three, with oral acetazolamide suspension in most cases. The total success rate (absolute and clinical successes combined) was 81.9% after 1 year of the treatment. There was no drop in visual acuity or cases of serious complications. There is a positive and significant correlation between prior glaucoma surgery and the need for reinterventions (p = 0.028). Micropulse transscleral cyclophotocoagulation (MPTSCPC) is an effective and safe procedure for reducing IOP within a broad spectrum of glaucoma patients. Additional studies are needed to confirm the current indications, widen their scope, and determine the optimal treatment settings on an individual basis. Basto RC, Almeida J, Roque JN, et al. Clinical Outcomes of Micropulse Transscleral Cyclophotocoagulation: 2 Years of Experience in Portuguese Eyes. J Curr Glaucoma Pract 2023;17(1):30-36.

Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure.

To evaluate the effects of micropulse transscleral cyclophotocoagulation (mCPC) and selective laser trabeculoplasty (SLT) on endothelial cell density (ECD) and reduction of the intraocular pressure (IOP) in patients with primary-open angle glaucoma (POAG). In this observational, retrospective study, 40 eyes with POAG were included. Patients were divided into three groups-group I was treated with SLT (n = 13), group II was treated with mCPC (n = 13), and group III included age-matched patients with medically treated glaucoma (n = 14) (control group). In both treatment groups (SLT and mCPC) preoperative and postoperative findings of best-corrected visual acuity (BCVA), ECD, and IOP were compared to the control group. The mean time interval before and after the treatment was 215 ± 120 days in group I (SLT) and 273 ± 177 days in group II (mCPC). The follow-up for group III (control group) was 209 ± 103 days. In both treatment groups (SLT and mCPC) there was a statistically significant reduction of the IOP postoperatively (group I: 3.5 ± 3.7 mm Hg (p = 0.005) and group II: 4.3 ± 4.1 mm Hg (p = 0.003)). The mean IOP for group III was 12.9 ± 3.7 mm Hg at visit 1 and did not change significantly (p = 0.353) at visit 2. In all three groups, there was no statistically significant change in ECD at the last visit. According to our results, both SLT and mCPC seem to be effective in lowering the IOP, without showing any statistically significant effect on ECD in patients with POAG.However, larger and longer-term studies are necessary to understand the effects of the SLT and mCPC procedures on ECD. Garip Kuebler A, Priglinger S, Reznicek L. Micropulse Cyclophotocoagulation vs Selective Laser Trabeculoplasty: Effects on Corneal Endothelial Cells and Intraocular Pressure. J Curr Glaucoma Pract 2023;17(1):40-43.

Slow-coagulation transscleral cyclophotocoagulation laser treatment for medically uncontrolled secondary aphakic adult glaucoma.

This study evaluates the outcomes of slow-coagulation continuous wave transscleral cyclophotocoagulation (CW-TSCPC) laser for treating secondary aphakic adult glaucoma after complicated cataract surgery as a primary surgical intervention. Retrospective chart review of adult aphakic eyes with medically uncontrolled glaucoma underwent slow-coagulation CW-TSCPC as a primary surgical glaucoma intervention was performed. Surgical success was the primary outcome measure. Success was defined as intraocular pressure (IOP) between 6 - 21 mmHg with ≥20% reduction compared to baseline and no need for further glaucoma surgeries or development of vision-threatening complications at 1-year follow-up. The secondary outcomes included changes in IOP, glaucoma medication numbers, visual acuity, and postoperative complications 1 year after laser treatment. This study included forty-one eyes of 41 patients. The mean age of study participants was 66.7±13.1 years, with a mean follow-up duration of 19±3.5 months. At one year, the success rate was 63.4%. A statistically significant reduction of the IOP was observed, with the mean IOP decreasing from 29.6±5.8 mmHg with a mean of 3.9±1.0 medications at baseline to a mean of 19.0±6.4 mmHg with a mean of 2.5±1.2 medications at 12 months ( P <0.001). Four eyes received CW-TSCPC retreatment, and two eyes required incisional glaucoma surgeries. Reported postoperative complications included: visual acuity decline ≥2 lines in 7 eyes, iritis in 6 eyes, hyphema in 5 eyes, cystoid macular edema in 2 eyes, and transient hypotony in 1 eye. Slow-coagulation CW-TSCPC is an efficacious, relatively safe, and non-incisional laser treatment option as an initial surgical glaucoma management choice with secondary aphakic adult glaucoma that is medically uncontrolled.

Micropulse Transscleral Cyclophotocoagulation Results in Secondary Glaucoma.

The aim of this study was to analyze the long-term outcome of first session of micropulse transscleral cyclophotocoagulation (MP-CPC) for refractory glaucoma developed after vitreoretinal surgery combined with silicone oil implantation. The inclusion criteria of this consecutive case series were: patients with secondary glaucoma in the refractory stage who underwent MP-CPC between 2018 and 2021, vitreoretinal surgery combined with silicon oil implantation, and at least a 24-month follow-up period after MP-CPC. Success was defined as the baseline eye pressure reduced at least 20%, and it should be ranged between 10 to 20 mmHg without further MP-CPC at the end of the follow-up. For this retrospective study, 11 eyes of 11 patients were selected. The reduction in IOP was found to be significant (p = 0.004) at the end of the follow-up time, and the success rate was 72% according to our results. The change in the number of antiglaucoma agents in the administered eyedrops was not significant compared to the baseline values. At the end of the follow-up period the change in BCVA values was not significant (p = 0.655). Our results confirm significant IOP lowering effect of this subthreshold method preserving visual performance safely even in eyes with previous vitrectomy surgery with a silicone oil implantation.

A prospective comparison of continuous wave and micropulse transscleral laser cyclophotocoagulation for refractory glaucoma in African eyes

Aims: To report the efficacy of transscleral diode laser photocoagulation and compare outcomes between the continuous wave (CW) and micropulse wave (MP) protocols for refractory glaucoma in African eyes. Methods: A non-randomized prospective comparative study of patients who had transscleral diode laser photocoagulation for refractory glaucoma between January 2021 and December 2021in Eye Foundation Hospital Lagos, Nigeria was done. Results: A total of 52 eyes of 52 patients were analyzed. Mean age of patients was 66 ± 12.5 years. The mean preoperative intraocular pressure (IOP) was 31.2 ± 11.9 mmHg. Overall post-operative mean IOP was 17.9 ± 8.6 mmHg at 4 weeks, 21.0 ± 9.9 mmHg at 8 weeks and 20.6 ± 11.4 mmHg at 12 weeks. The difference between mean preoperative and postoperative IOP measured at week 12 was statistically significant (p&lt;0.001). Both continuous wave and micropulse wave protocols were effective at reducing intraocular pressures, the micropulse group had a mean difference between preoperative IOP and postoperative IOP at week 12 of 7.5 ± 6.7 mmHg (p=0.001), while the continuous wave laser group had a mean difference of 11.7 ± 13.7 mmHg (p&lt;0.001). The micropulse group achieved a higher percentage of success in 11 eyes (78.6%) compared with 24 eyes (63.2%) in the continuous wave group. This difference was not statistically significant (p=0.341). Conclusion: Both the continuous wave (CW) and micropulse wave (MP) protocols of transscleral diode laser photocoagulation were found effective at significantly reducing IOP in our study of African eyes with refractory glaucoma. Although the MP group achieved a higher percentage of absolute success, this was not statistically significant.

Transscleral vs endoscopic cyclophotocoagulation: safety and efficacy when combined with phacoemulsification

PurposeTo compare the effectiveness and safety of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco/ECP), phacoemulsification combined with MicroPulse transscleral cyclophotocoagulation (phaco/MP-TSCPC), and phacoemulsification alone (phaco) in the treatment of coexisting cataract and glaucoma.MethodsRetrospective cohort study of consecutive cases at Massachusetts Eye & Ear. The main outcome measures were the cumulative probabilities of failure between the phaco/ECP group, phaco/MP-TSCPC group, and the phaco alone group with failure defined as reaching NLP vision at any point postoperatively, undergoing additional glaucoma surgery, or the inability to maintain ≥ 20% IOP reduction from baseline with IOP between 5–18 mmHg while maintaining ≤ baseline medications. Additional outcome measures included changes in average IOP, number of glaucoma medications, and complication rates.ResultsSixty-four eyes from 64 patients (25 phaco/ECP, 20 phaco/MPTSCPC, 19 phaco alone) were included in this study. The groups did not differ in age (mean 71.04 ± 6.7 years) or length of follow-up time. Baseline IOPs were significantly different between groups (15.78 ± 4.7 mmHg phaco/ECP, 18.37 ± 4.6 mmHg phaco/MP-TSCPC, 14.30 ± 4.2 mmHg phaco alone, p = 0.02). Primary open-angle glaucoma was the most common type of glaucoma in the phaco alone (42%) and phaco/ECP (48%) groups while mixed-mechanism glaucoma was the most common type in the phaco/MP-TSCPC group (40%). Surgical failure was less likely in eyes in the phaco/MP-TSCPC (3.40 times, p = 0.005) and phaco/ECP (1.40 times, p = 0.044) groups compared to phaco alone based on the Kaplan–Meier survival criteria. These differences maintained statistical significance when differences in preoperative IOP were taken into account using the Cox PH model (p = 0.011 and p = 0.004, respectively). Additionally, surgical failure was 1.98 times less likely following phaco/MP-TSCPC compared to phaco/ECP (p = 0.038). This difference only approached significance once differences in preoperative IOP were accounted for (p = 0.052). There was no significant difference in IOP reduction at 1 year between groups. Mean IOP reductions at 1 year were 3.07 ± 5.3 mmHg from a baseline of 15.78 ± 4.7 in the phaco/ECP group, 6.0 ± 4.3 mmHg from a baseline of 18.37 ± 4.6 in the phaco/MP-TSCPC group and 1.0 ± 1.6 from a baseline of 14.30 ± 4.2 mmHg in the phaco alone group. There were no differences in complication rates among the three groups.ConclusionsBoth Phaco/MP-TSCPC and phaco/ECP appear to provide superior efficacy for IOP control when compared to phaco alone. All three procedures had similar safety profiles.

Proliferative Vitreoretinopathy Following Transscleral Diode Cyclophotocoagulation.

Transscleral diode laser cyclophotocoagulation may trigger the development of proliferative vitreoretinopathy. Our article demonstrates one such case leading to tractional macula off retinal detachment in a child with aphakic glaucoma. The purpose of this article is to describe a case of proliferative vitreoretinopathy (PVR) developing subsequent to transscleral diode laser cyclophotocoagulation (cyclodiode) in a pediatric patient with aphakic glaucoma. PVR most commonly occurs following rhegmatogenous retinal detachment (RRD) repair however, to the best of our knowledge, has never been reported to appear after cyclodiode. Retrospective evaluation of case presentation and intraoperative findings. A 13-year-old girl with aphakic glaucoma presented four months after cyclodiode of the right eye with a retrolental fibrovascular membrane and anterior PVR. The PVR extended posteriorly over the next month after which the patient developed a tractional macula off retinal detachment. Pars Plana vitrectomy was performed confirming dense anterior and posterior PVR. Review of the literature suggests an inflammatory cascade, similar to that seen in PVR development following RRD, may occur from the destruction of the ciliary body by cyclodiode. As a result, fibrous transformation may occur, likely accounting for the cause of PVR development in this case. The pathophysiology of PVR development remains unclear. This case demonstrates that PVR may occur following cyclodiode and should be considered during post-operative monitoring after this procedure.

Two-year outcomes of patients presenting to Sydney Eye Hospital with neovascular glaucoma

BackgroundNeovascular glaucoma (NVG) is a sight-threatening condition that is often refractory to treatment. Current management principles are yet to be standardized due to lack of evidence. We studied the interventions used to treat NVG at Sydney Eye Hospital (SEH) and the two-year surgical outcomes.MethodsWe performed a retrospective audit of 67 eyes of 58 patients with NVG from January 1, 2013, to December 31, 2018. Intraocular pressure (IOP), best-corrected visual acuity (BCVA), number of medications, repeat surgery, recurrent neovascularization, loss of light perception and pain were studied.ResultsThe average age of the cohort was 59.67 years (SD 14.22). The most common etiologies were proliferative diabetic retinopathy (35 eyes; 52.2%), central retinal vein occlusion (18 eyes; 26.9%) and ocular ischemic syndrome (7 eyes; 10.4%). 70.1% of eyes (47) received vascular endothelial growth factor injections (VEGFI), 41.8% (28 eyes) received pan-retinal photocoagulation (PRP) and 37.3% (25 eyes) received both prior to or within the first week of presentation to SEH. The most common initial surgical interventions were trans-scleral cyclophotocoagulation (TSCPC) (36 eyes; 53.7%) and Baerveldt tube insertion (18 eyes; 26.9%). 62.7% of eyes (42 eyes) failed (IOP > 21 or < 6 mmHg for two consecutive reviews, further IOP-lowering surgery or loss of light perception) during follow-up. Initial TSCPC failed in 75.0% (27/36 eyes) compared with 44.4% (8/18 eyes) after Baerveldt tube insertion.ConclusionOur study reinforces the refractory nature of NVG, often despite intensive treatment and surgery. Improvements in patient outcomes may be achieved with earlier consideration of VEGFI and PRP. This study identifies the limitations of surgical interventions for NVG and highlights the need for a standardized management approach.

Comparison of two protocols of diode laser transscleral cyclophotocoagulation in refractory glaucoma.

Diode laser transscleral cyclophotocoagulation (DLTSCPC) remains the most commonly used cyclodestructive procedure. Nonetheless, there is no common consensus on a standardized technique. In this prospective randomized pilot study we compare the "pop"-titrated and "slow-burn" DLTSCPC techniques for a follow-up period of 3 months. The major outcomes of this study were intraocular pressure (IOP) before and after the procedure and the incidence of adverse events. Furthermore, postoperative pain, postoperative intraocular inflammation and corrected distance visual acuity (CDVA) were evaluated. Mean baseline IOP decreased from 37.9 ± 12.7 mmHg in the pop group and 41.2 ± 9.6 mmHg in the slow-burn group to 20.3 ± 13.9 mmHg and 21.3 ± 13.4 mmHg at the final follow-up visit, corresponding to a 45.8 ± 31.7% and 46.3 ± 32.6% reduction respectively. 64.3% and 57.1% of patients had IOP ≥6 and≤ 21 mmHg in the pop and slow-burn groups respectively. The occurrence of adverse events was similar in both groups, with 1 case of hyphema in the pop group and 2 cases in the slow-burn group, and 1 case of hypotony in each group. Mean CDVA remained unchanged until the end of follow-up from 2.05 ± 0.84 to 2.04 ± 0.8 logMAR in the pop group and from 1.93 ± 0.78 to 1.89 ± 0.7 logMAR in the slow-burn group. Nonetheless, 4 eyes in each group encountered CDVA loss. Postoperative pain and inflammation were also similar between groups. At the 3rd postoperative month, safety and efficacy was similar in the two techniques. The relative ease of the slow-burn technique may make its application more appealing to ophthalmic surgeons beyond glaucoma specialists.

Trends in operating room-based glaucoma procedures at a single eye center from 2016-2020.

To evaluate trends in glaucoma procedures at the Peking University Eye Center in 2016-2020. A retrospective search of all glaucoma procedures performed at our institution were performed. Data were analyzed by calculating the absolute numbers and relative weightage of each procedure per year. The average age of glaucoma patients undergoing surgical procedures was 62.33±17.87y, and 55% were women. From 2016 to 2019, the number of surgical procedures performed in glaucoma patients showed an overall upward trend from 749 to 1460, although it decreased slightly in 2020 (n=1393), probably due to the COVID-19 pandemic. The number of trabeculectomies did not change significantly in 2016 (n=161) to 2018 (n=164) but decreased in 2019 (n=139) to 2020 (n=121), indicating a reduction in its relative weightage among glaucoma procedures (from 21.50% to 8.69%). The number of glaucoma drainage device implantations and minimally invasive glaucoma surgeries both increased (50 and 58 respectively in 2019), except in 2020. The number of transscleral cyclophotocoagulation procedures was relatively stable, increasing until 2017 (n=218) and then decreasing. Cataract surgeries with or without glaucoma procedures accounted for a large number of the total surgeries, increasing from 247 (32.97%) in 2016 to 967 (69.42%), among which cataract extraction combined with goniosynechialysis was the most frequent. The overall increase in the number of operating room-based surgical procedures is significant. Trabeculectomy is one of the most commonly performed procedures, despite the relative decline in its weightage. Other procedures, including use of glaucoma drainage devices and mini shunts and minimally invasive glaucoma surgeries, are gaining greater acceptance. Notably, lens-related surgery plays an important role in glaucoma management.

Метод оценки потребности и типа повторной операции при хирургическом лечении глаукомы с применением искусственной нейронной сети

Relevance. The problem of evaluating the choice of treatment method for patients with glaucoma is widely covered in the medical literature, but currently there are no publications on indications and decision making about reoperation in case of complete or partial ineffectiveness of the treatment. Purpose. To describe a method for assessing the need and type of reoperation in the surgical treatment of glaucoma using an artificial neural network. Material and methods. 7801 cases of observation and treatment of patients diagnosed with glaucoma were selected for 2018 –2020. The development and statistical analysis of the factors associated with repeated surgical operations was carried out, a model for predicting the probability of repeated operations was created, mathematical modeling of the onset of complications depending on the identified factors was carried out using the method of constructing classification trees. The resulting model was used to assess the need for surgical treatment in patient registered in clinic in 2019. Cases of specialized medical care have been identified, in which, with a high degree of probability, long-term compensation of the pathological course of glaucoma will not occur and repeated surgical treatment will be required. These cases were copied into a separate database for further work. The preferred reoperation method for patient management was selected using an artificial neural network. Results. A number of factors that are statistically significantly associated with reoperation have been identified, and an artificial neural network model has been created to predict the type of reoperation in glaucoma. Application of the obtained method on patients who received treatment at the clinic in 2019 –2021 years made it possible to predict the probability of reoperation within a three-year follow-up period in 5%, while among the patients the need for treatment was distributed as follows: microfistulizing deep sclerectomy with allodrainage – 88.37%, selective laser trabeculoplasty – 6.98%, transscleral cyclophotocoagulation – 4.65%. Conclusion. The obtained method allows predicting the probability of re-treatment of glaucoma and the type of surgery required. Considering the specificity and sensitivity of the obtained models, it is necessary to increase the number of observations, further clinical and organizational study of aspects of the provision of medical services in previously operated glaucoma, and an assessment of the clinical and economic effect of the introduction of this method. Keywords: glaucoma, artificial neural network, assessment method

Postoperative Pain after Different Transscleral Laser Cyclophotocoagulation Procedures.

As the number of surgical options in glaucoma treatment is continuously rising, evidence regarding distinctive features of these surgeries is becoming more and more important for clinicians to choose the right surgical treatment for each individual patient. For this retrospective data analysis, we included glaucoma patients treated with either continuous wave (CW-TSCPC) or micropulse transscleral cyclophotocoagulation (MP-TSCPC) in an inpatient setting. Pain intensity was assessed using a numeric rating scale (NRS) ranging from 0 (no pain) to 10 (worst imaginable pain) during hospitalization. CW-TSCPC was performed using OcuLight® Six (IRIDEX Corporation, Mountain View, CA, USA) and MP-TSCPC was performed using the IRIDEX® Cyclo-G6 System (IRIDEX Corporation, Mountain View, CA, USA). A total of 243 consecutive cases of TSCPC were included. Of these, 144 (59.26%) were treated with CW-TSCPC and 99 (40.74%) with MP-TSCPC. Using the univariable model, the risk for postoperative pain was observed to be lower in MP-TSCPC compared with CW-TSCPC (unadjusted: OR 0.46, 95% CI 0.24-0.84, p = 0.017), but this did not hold using the multivariable model (adjusted: OR 0.52, 95% CI 0.27-1.02, p = 0.056). Simultaneously conducted anterior retinal cryotherapy was associated with a higher risk for postoperative pain (OR 4.41, 95% CI 2.01-9.69, p < 0.001). We found that the occurrence of postoperative pain was not different in CW-TSCPC compared with MP-TSCPC in a multivariable model. In cases of simultaneous anterior retinal cryotherapy, the risk for postoperative pain was significantly higher.

Success rate in micropulse diode laser treatment with regard to lens status, refractive errors, and glaucoma subtypes.

To evaluate the efficacy of micropulse transscleral cyclophotocoagulation (MP-TSCPC) considering different characteristics: glaucoma subtypes and lens status. A retrospective case-series study was designed to evaluate intraocular pressure (IOP), and the number of IOP-lowering medications, used by glaucoma patients treated with MP-TSCPC between 2016 and 2019. Cases had a follow-up period of 12months. Achieving an IOP reduction higher than 20%, or the decrease of at least one IOP-lowering medication, was considered a successful outcome. The same population was analyzed by classifying them in two groups as: glaucoma subtypes and lens status. The baseline spherical equivalent (SE) was also calculated for considering association with the achieved IOP. A total of 86 eyes were included. In most cases, IOP and IOP-lowering medications were decreased with a statistically significant difference (p < 0.0001), and all of them had a successful outcome. The percentage of IOP drop oscillated between 25.9% (open-angle glaucoma sub-group) and 37.5% (pseudoexfoliative glaucoma sub-group), 12months after surgery. The difference between the groups was not statistically significant (p 0.20 and 0.32 for glaucoma subtypes and lens status, respectively). The Pearson's coefficient obtained was low for the SE and IOP association, at the 12 -month postoperative mark (- 0.009; p < 0.001). The MP-TSCPC treatment was successful in decreasing IOP and IOP-lowering medications, in different glaucoma subtypes. Differences between groups (glaucomasubtypes, phakic and pseudophakic eyes) were not statistically significant. No association was found between the SE and the IOP achieved value after MS-TSCPC treatment.

Outcomes of primary surgical treatment of medically recalcitrant post-keratoplasty glaucoma with transscleral cyclophotocoagulation.

To report the outcomes of slow-coagulation continuous-wave transscleral cyclophotocoagulation (CW-TSCPC) in post-keratoplasty glaucoma refractory to medical therapy. Medical records of 47 patients (mean age of 70.7 ± 15.7 years and follow-up of 13.9 ± 7.1 months) were retrospectively enrolled. All patients had the diagnosis of secondary glaucoma after penetrating keratoplasty (PKP; n = 28) or Descemet's stripping automated endothelial keratoplasty (DSAEK; n = 19) with no previous history of incisional glaucoma or TSCPC surgeries. Study participants underwent slow-coagulation CW-TSCPC (1250-milliwatt power and 4-second duration). A statically significant reduction of IOP from 31.8 ± 8.0 mmHg preoperatively to 16.9 ± 9.0 mmHg postoperatively was noted (p < 0.001). Similarly, the number of glaucoma medications decreased from 4.0 ± 1.0 to 2.7 ± 1.4 (p < 0.001). The overall success rates at 12 and 24 months were 68.1% and 66.0%, respectively, with no difference in success rates between post-PKP and post-DSAEK subgroups (p = 0.836). No significant changes in VA or central corneal thickness (CCT) were observed (p = 0.345 and 0.311, respectively). One (3.3%) patient had a graft rejection. The majority of the complications noted during this study were mild and transient. Our study suggests that slow-coagulation TSCPC may be a safe and efficient surgical glaucoma treatment modality in patients with medically uncontrolled post-keratoplasty glaucoma.

Traumatic Posterior Chamber Intraocular Lens Dislocation into the Subconjunctival Space

Purpose: Here we report a case of posterior chamber intraocular lens (IOL) dislocation into the subconjunctival space (pesudophacocele) following ocular trauma.Case summary: A 66-year-old male presented with ocular pain and decreased vision in the right eye following trauma with a metallic rod. The patient had a history of trabeculectomy, glaucoma drainage device implantation, transscleral cyclophotocoagulation, and cataract surgery for uveitic glaucoma and a cataract in the right eye. On examination, vision was hand movement, the intraocular pressure was 3 mmHg, and subconjunctival hemorrhage and hyphema were observed. After the resolution of hemorrhage, uveal tissue prolapse was seen nasally behind the corneal limbus and the IOL was found to be dislocated into the nasal subconjunctival space. There were no changes in the filtering bleb and tube compared to the pre-trauma status. The IOL was removed through a conjunctival incision because the patient refused any active treatment.Conclusions: Pesudophacocele developed in a patient who had a history of glaucoma and cataract surgery in the injured eye. The IOL could not be assessed immediately after the trauma because of subconjunctival hemorrhage and hyphema. When the status of IOL is unclear or suspected to be dislocated after trauma, the possibility of pseudophacocele should be considered, in addition to the dislocation into the vitreous cavity.

Plateau Iris: A Review.

To review the concept of plateau iris and summarize the recent evidence on its diagnosis and management. This is a narrative review on the plateau iris. A literature review was conducted in PubMed, Google Scholar, and Scopus databases using keywords: angle-closure glaucoma, glaucoma, nonpupillary block glaucoma, plateau iris, and plateau iris management. This review defined the current knowledge about plateau iris. First of all, the anatomy and epidemiology were discussed. Then, we outlined the available evidence on the diagnosis of plateau iris and its differential diagnosis. Conclusively, the treatment options were mentioned. Plateau iris is a condition in which nonpupillary block mechanisms are responsible for intraocular pressure elevation and angle closure attack when a patent peripheral iridotomy has removed the relative pupillary block. An anteriorly positioned ciliary body causes mechanical obstruction of trabecular meshwork in these patients. It is usually seen in younger patients with angle closure and is diagnosed by gonioscopic examination and imaging modalities such as Ultrasound biomicroscopy. Despite the known mechanism of plateau iris, there is no consensus over treatment. Low-dose pilocarpine and Argon laser peripheral iridoplasty are nonsurgical treatments for these patients, but their effects are short-term. Cataract extraction with/without endocyclophotocoagulation (ECP), endocycloplasty, excisional goniotomy, and transscleral cyclophotocoagulation are alternative treatments. Patients should be examined periodically for further progression or recurrence of plateau iris. In cases of glaucoma unresponsive to conventional medical treatments, surgical treatments such as trabeculectomy and drainage devices should be considered.

Rehabilitation of patients with posttraumatic aniridia and secondary glaucoma

This study analyzes the long-term results of rehabilitation of patients with posttraumatic aniridia and glaucoma. The study included 310 patients (310 eyes) with posttraumatic aniridia who had artificial iris-lens diaphragm (ILD) MIOL-Raduzhka implanted in 2002-2022. Before ILD implantation, 61 patients (22.8%) had secondary glaucoma. Among them 35 patients (11.3%) underwent various modifications of glaucoma surgery. In 26 patients (8.6%), intraocular pressure (IOP) was compensated medically before ILD implantation. Until the third month after ILD implantation, there was a trend for IOP increase in some patients. Decompensation was noted in 8 (22.9%) out of 35 patients who had underwent glaucoma surgery. IOP decompensation was observed in 21 (80.8%) of 26 cases in patients with glaucoma compensated by drugs before ILD implantation. After ILD implantation, glaucoma appeared for the first time in 21 patients (6.8%) out of 310. In order to compensate IOP after ILD implantation, Ahmed valve implantation was performed most often - in 35 cases (70%) out of 50, deep sclerectomy - in 5 cases (10%), non-penetrating deep sclerectomy - in 4 cases (8%), micropulse transscleral laser cyclophotocoagulation (MP-TSCPC) - in 5 cases (10%), endoscopic cyclophotocoagulation (ECP) - in 1 case (2%). ILD implantation in patients with posttraumatic aniridia and secondary glaucoma should be performed with IOP compensated without hypotensive therapy and not earlier than 6-12 months after glaucoma surgery. The most optimal glaucoma surgery types in this group of patients are Ahmed valve implantation and MP-TSCPC.