Transscleral Cyclophotocoagulation Research Articles

Хирургическая стимуляция увеосклерального оттока как альтернатива циклодеструктивным методам лечения глаукомы

Aim: to assess clinical efficacy and safety of surgical scleral rejection (SSR) vs. transscleral diode laser cyclophotocoagulation (TSCPC) in primary open-angle glaucoma (POAG) and secondary glaucoma (SG). Patients and Methods: study (prospective) group included 84 patients with POAG and SG after SSR. Control (retrospective) group included 80 patients after TSCPC. In addition, the patients were distributed by age and the stage and type of glaucoma, i.e., 128 patients were diagnosed with POAG and 36 patients were diagnosed with secondary thrombotic glaucoma. Follow-up was 24 to 36 months. IOP measurements, tonography (to assess the coefficient outflow facility / COF), ultrasound biomicroscopy of the anterior segment, visual acuity measurement, and visual field testing were performed. Results: no complications after SSR were reported in patients with POAG and SG. In contrast, postoperative complications (choroidal effusion, hyphema, and uveitis) were reported in 14% of patients after TSCPC. Long-term IOP-lowering efficacy of both procedures was similar (87% after SSR and 89% after TSCPC). In POAG, greater IOP reduction was seen after TSCPC (by 39.11%) compared to SSR (by 31.58%) (p<0.05). Meanwhile, in patients with SG, treatment outcomes were similar (IOP reduced by 36.78% after TSCPC and by 35.26% after SSR). In longterm follow-up, PVF reduced by 10.76% vs. baseline after TSCPC but increased by 11.19% vs. baseline after SSR (p≤0.05). Surgery resulted in the improvement or stabilization of visual functions. Ultrasonography has demonstrated that outflow pathways (intrascleral space and filtering bleb) remain functional after SSR in long-term follow-up. Conclusion: SSR is an alternative to cyclodestructive procedures in POAG and SG. Sclera being the final point of the uveoscleral outflow is a perspective entity to develop surgical approaches to glaucoma treatment. Keywords: surgical scleral resection, uveoscleral outflow, sclera, primary open-angle glaucoma, secondary glaucoma, glaucoma surgery, transscleral diode laser cyclophotocoagulation. For citation: Korchuganova E.A., Kazantzeva A.Yu. Surgical stimulation of uveoscleral outflow is an alternative to cyclodestructive procedures. Russian Journal of Clinical Ophthalmology. 2021;21(1):9–13. DOI: 10.32364/2311-7729-2021-21-1-9-13.

EFFICACY OF CYCLOCRYOTHERAPY AND TRANSSCLERAL DIODE LASER CYCLOPHOTOCOAGULATION IN THE MANAGEMENT OF REFRACTORY GLAUCOMA.

SUMMARYTreating advanced glaucoma often requires numerous therapeutic modalities in order to achieve the desired intraocular pressure (IOP) reduction. The purpose of this study was to evaluate the IOP lowering efficacy of both cyclocryotherapy (CCT) and transscleral diode laser cyclophotocoagulation (TS-DCPC) in the management of refractory primary open-angle glaucoma. This prospective, randomized, controlled clinical trial included 40 patients (40 eyes) with refractory glaucoma treated at the Eye Department, Clinical Center of Vojvodina, Novi Sad, Serbia, between January 2016 and June 2019. Twenty patients underwent CCT (group 1), while another twenty patients were treated with TS-DCPC (group 2). Each patient underwent complete eye examination on the treatment day, as well as follow-up eye examinations 7 days and 1, 6 and 12 months after the intervention, when IOP and number of anti-glaucoma drugs used were recorded. The median baseline IOP was 36.50 mm Hg (IQR, 28.75-42.00) in group 1 and 27.00 mm Hg (IQR, 22.00-35.00) in group 2. Follow-up measurements of IOP in group 1 showed the following results: 16.50 mm Hg (IQR, 7.75-20.00) (60% decrease from the baseline value), 12.00 mm Hg (IQR, 9.25-18.00) (67% decrease from the baseline value), 9.00 mm Hg (IQR, 2.00-13.75) (73% decrease from the baseline value), and 9.50 (IQR, 2.50-12.00) (75% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. Follow-up measurements of IOP in group 2 showed the following results: 16.00 mm Hg (IQR, 10.00-17.00) (48% decrease from the baseline value), 14.00 mm Hg (IQR, 10.00-16.00) (56% decrease from the baseline value), 14.00 mm Hg (IQR, 12.25-16.50) (43% decrease from the baseline value) and 14.00 mm Hg (IQR, 11.25-15.75) (53% decrease from the baseline value) after 7 days, 1, 6 and 12 months, respectively. The mean number of antiglaucoma drugs used decreased from 4 to 0.65±0.81 and 2.25±1.07 in groups 1 and 2, respectively. In conclusion, study results confirmed the CCT and TS-DCPC to have a rapid and statistically significant ocular hypotensive effect in eyes with refractory glaucoma at one-year follow-up.

СРАВНИТЕЛЬНЫЙ АНАЛИЗ РЕЗУЛЬТАТОВ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ ОТКРЫТОУГОЛЬНОЙ ГЛАУКОМЫ МЕТОДАМИ МИКРОИМПУЛЬСНОЙ ТРАНССКЛЕРАЛЬНОЙ ЦИКЛОФОТОКОАГУЛЯЦИИ И СИНУСТРАБЕКЛЭКТОМИЕЙ

Purpose of the study: Evaluate the efficiency and compare results of micropulse transscleral cyclophotocoagulation(mCPC) and trabeculectomy in treatment of patients with open-angle glaucoma of stages 1—3. Materials and methods: In our study 67 surgical interventions were performed to reduce the level of IOP. The patients were divided into two groups depending on the used surgical technique: group I (study) — 34 eyes (21 patients) which underwent micropulse transscleral cyclophotocoagula- tion, group II (comparison) — 33 eyes (33 patients), trabeculectomy was performed. The groups were comparable in terms of the main indicators affecting the final treatment outcome. During the period of observation the level of intraocular pressure, the best corrected visual acuity, visual fields, cup-to-disc ratio and the amount of antiglaucoma drugs used were determinated. Results: In both groups, a statistically significant decrease in IOP was achieved at the end of the observation period (p < 0.001), the groups were comparable in terms of this indicator (p = 0.61). There was a statistically significant decrease in the number of drugs taken (p < 0.001) in both groups. Comparison of groups I and II showed a statistically significant difference in terms of the indicator at the observation periods of 3, 6 and 12 months, and the absence thereof after 18 months (p = 0.072). BCVA in group I was stable (p = 0.53 after 18m.), In group II, statistically insignificant positive dynamics in BCVA were observed (p = 0.046 at pcrit. = 0.125 after 18m). Both groups were comparable throughout the observation period in terms of CDR and the MD of the retina light sensitivity. Group I patients did not require additional surgical treatment, 9 patients of group II underwent 12 additional interventions aimed at treating complications. Conclusion: Micropulse transscleral cyclophotocoagulation allows to achieve a pronounced decrease in the IOP level and a decrease in the number of the applied drugs. MCPC is comparable in efficiency with trabeculectomy, in the absence of complications that require additional surgical treatment and affect the success of treatment, which is typical for trabeculectomy. The use of mCPC provides a stable course glaucomatous neuroopticopathy comparable to trabeculectomy.

A rare case of early neurotrophic keratitis following micropulse transscleral cyclophotocoagulation combined with phacoemulsification

A rare case of early neurotrophic keratitis following micropulse transscleral cyclophotocoagulation combined with phacoemulsification

Микроимпульсная транссклеральная циклофотокоагуляция: современный подход к лечению глаукомы

The article presents new laser technology in the treatment of glaucoma using a Micro-Pulse laser. It describes the technique, optimal energy regimes, differential indications, contraindications, timing of laser intervention, effectiveness of treatment, and possible complications. It also compares a number of advantages, alternatives and safety of this method in comparison with other traditional laser cyclodestructive interventions. It essentially concludes that this technology is highly effective and safe in the treatment of primary open-angle glaucoma at various stages and refractory forms of glaucoma is based on date of clinical and morphological studies described in literature. This work also advocates further extended study of microimpulse transscleral cyclophotocoagulation in the treatment of combined glaucoma and other forms of ocular pathology as well as further extended study of microimpulse transscleral cyclophotocoagulation in the treatment of glaucoma-associated pathology and other eye diseases.

Micropulse Transscleral Cyclophotocoagulation: Our Experience

Introduction Traditionally, ciliary body destruction has been used to treat uncontrolled intraocular pressure (IOP) following maximally tolerable medical therapy. This is due to the large number of complications seen with this procedure. However, recently a new technique of sub-threshold laser or micropulse laser, is able to provide selective destruction of the ciliary body in a controlled manner. This avoids most of the complications seen with other modalities. We have performed a small case descriptive pilot study to assess the effectiveness of micropulse transscleral cyclophotocoagulation (MP-TSCPC) in lowering IOP. Methods This pilot study was conducted on four patients in the age range 55-70-years with intractable glaucoma. Two patients had primary angle closure glaucoma, one-each had steroid-induced glaucoma and neovascular glaucoma. Mean baseline IOP was 32±2.4 mmHg. Mean number of glaucoma medications were 2.5±1.5. All patients underwent 180° MP-TSCPC. Absolute success was defined as IOP<20 mmHg without acetazolamide. Results Following the procedure the patients were followed-up at days 1,7,30 and 90. At the last follow-up of the study, mean IOP was 18.2±1.2 mmHg in all four patients. Mild anterior chamber inflammation was the only complication noted. Mean number of glaucoma medications reduced to 1.5±1.0 following the procedure. Thus, absolute success was achieved in all patients. Conclusion This small pilot study validates other studies which show effectiveness of MP-TSCPC as an efficient and safe procedure to lower IOP. This procedure can be used over a wide variety of cases, though the indications for such procedures are still evolving. More extensive and long-term studies will clarify the position of this procedure in our glaucoma management practices.

Laser trabeculoplasty and subthreshold transscleral cyclophotocoagulation – the new therapeutic options are modifying therapeutic algorithm in glaucoma

Selective laser trabeculoplasty (SLT) and micropulse laser trabeculoplasty (MLT) are well established, non-invasive laser procedures in glaucoma, but their place in the therapeutic algorithm still evolves. Lately published multicenter randomized clinical trials indicate the need to consider laser trabeculoplasty as the first-line treatment before medications in primary open-angle glaucoma an ocular hypertension due to its favorable safety profile, efficacy and cost-effectiveness. Subthreshold transscleral cyclophotocoagulation (present on the market under different brand names: SubCyclo® TS-CPC [Quantel, France] or Cyclo G6® mTS-CPC [Iridex, USA]) is an antiglaucomatous laser procedure, recently arousing more and more interest in ophthalmologists as a new non-invasive method in our therapeutic portfolio. This new device utilizes 810 nm diode laser beam, fractionated into ultra-short pulses, resulting in low energy spots without causing ciliary body coagulation. Subthreshold (or subliminal) energy delivered during the session spares the tissue due to very limited local heat accumulation zone and therefore this procedure may be repeated. Laser energy partially disables aqueous producing ciliary epithelium and opens supraciliary space thus activating the additional outflow facility. Subthreshold TS-CPC in several clinical trials proved to be effective in lowering the intraocular pressure and devoid of significant sight threatening side effects, comparing to the classical thermal diode cyclophotocoagulation method.

US: Nouryon – Expancel

To report treatment outcomes of primary transscleral cyclophotocoagulation (TSCPC) in glaucomatous eyes.Retrospective noncomparative study.Forty-eight eyes with a diagnosis of glaucoma and no previous incisional ocular surgery.Continuous-wave TSCPC was applied to the ciliary body.The primary outcome measure was surgical success defined as an IOP ≤ 21 mmHg and reduced by 20% or more from baseline, IOP > 5 mmHg, no reoperation for glaucoma, and no loss of light perception vision. Secondary outcome measures included visual acuity (VA) and complications.Glaucoma eyes were stratified into 2 groups: (1) those with pretreatment IOP >21 mmHg (high group) and (2) those with pretreatment IOP ≤ 21 mmHg (low group). Mean ± standard deviation (SD) IOP at baseline was 30.6 ± 6.3 mmHg in the high group and 16.2 ± 2.8 mmHg in the low group. Mean ± SD number of glaucoma medications at baseline was 4.1 ± 0.8 in the high group and 3.6 ± 1.1 in the low group. Based on our success criteria, the cumulative probability of success during the first year of follow-up was 58.3% in the high group and 28.1% in the low group (P = 0.052). Postoperative mean IOP was significantly lower than baseline IOP in the high group at 1-, 3-, 6-, 12-, and 18-month postoperative visits (P < 0.05). No significant change was observed in IOP at follow-up visits after 1 month in the low IOP group. Throughout the first year of follow-up, both groups required fewer glaucoma medications compared with baseline at the 1-, 3-, 6-, and 12-month postoperative visits (P < 0.05). The most frequent cause of postoperative decrease in VA was cataract in 9 eyes. Decrease in vision resulting from glaucoma was observed in 3 eyes. Complications included prolonged inflammation (11 eyes), iris neovascularization (2 eyes), cystoid macular edema (4 eyes), and hyphema (1 eye). No severe or long-term complications were observed.Continuous-wave TSCPC was effective in lowering IOP in glaucoma patients without prior incisional ocular surgery whose disease was recalcitrant to medical therapy, particularly those with baseline IOP of more than 21 mmHg.

One-Year Follow-up of Pars Plicata Versus Pars Plana Application of Transscleral Micropulse Cyclophotocoagulation.

To compare the efficacy and safety of micropulse transscleral cyclophotocoagulation applied at the level of the pars plicata transscleral micropulse cyclophotocoagulation (PLI-MPC) versus the pars plana transscleral micropulse cyclophotocoagulation (PLA-MPC). This prospective interventional case series included 44 eyes of 31 medically treated primary open-angle glaucoma patients scheduled for micropulse transscleral cyclophotocoagulation to achieve further intraocular pressure (IOP) reduction. In total, 22 eyes underwent PLI-MPC and PLA-MPC each. Primary endpoints were the reduction of 24-hour mean diurnal IOP (mean of 6 measurements), diurnal IOP fluctuations, and peak IOP, after 3 and 12 months. Secondary outcomes were postoperative complications, a possible deterioration in visual acuity and field, factors influencing IOP reduction, and the number of dropouts. In the PLI-MPC group, IOP was reduced from 15.9±3.4 mm Hg to 13.6±3.1 mm Hg (n=16; P<0.001) and 12.9±3.7 mm Hg (n=13; P<0.001) at 3 and 12-month follow-up. In the PLA-MPC group, IOP decreased from 16.4±3.5 mm Hg to 12.3±2.6 mm Hg (n=15; P<0.001) and 11.8±2.2 mm Hg (n=14; P<0.001), respectively. At 12 months, 59% of the PLI-MPC and 63% of the PLA-MPC group had a sufficient IOP reduction to reach the individual target pressure. No complications were seen in either group. A higher preoperative IOP was recognized as the only factor influencing the postoperative IOP reduction. PLI-MPC and PLA-MPC seem to be safe and effective in further lowering the IOP in about 60% of patients with primary open-angle glaucoma who did not reach target pressure despite maximally tolerated IOP-lowering medication. Although the IOP-lowering effect was not statistically significantly different between groups the pars plicata application was superior and easier to perform and should be recommended as the preferred method of application.

Micropulse trans-scleral cyclophotocoagulation: treatment outcomes of refractory glaucoma in Malaysia

Introduction: A more novel form of cycloablation, micropulse cyclophotocoagulation (MPCPC), has gained popularity in recent years due to its proven efficacy in lowering intraocular pressure (IOP) as well as higher safety profile compared to conventional trans-scleral cyclophotocoagulation.&#x0D; Purpose: The aim of this study was to investigate the treatment outcome of MPCPC as an adjunctive treatment for refractory glaucoma.&#x0D; Study design: Retrospective interventional case series.&#x0D; Materials and methods: Subjects were patients with refractory glaucoma and glaucoma progression; with or without prior glaucoma surgery, who were not keen or not suitable for glaucoma surgery. Outcomes were IOP-lowering effect and reduction of glaucoma medications at 6 months follow-up. Treatment success was defined as either achieving IOP &lt; 21 mmHg or IOP reduction of 20% from baseline IOP.&#x0D; Results: The median age of patients was 57.5 years. A total of 34 eyes of 24 patients were treated with MPCPC with a mean follow-up period of 6 months. The majority of our patients (79%) experienced mild to moderate pain during the procedure. The median IOP prior to MPCPC was 30 mmHg and was significantly reduced at 1 week (17.5 mmHg), 1 month (17.5 mmHg), 3 months (21.0 mmHg), and 6 months (21.0 mmHg), with a 19.2% IOP reduction at the last follow-up. There were no cases of hypotony. The reduction in the number of glaucoma medications was not statistically significant. Our treatment success rate after a mean of 1.1 treatment sessions was 53% (16 out of 34 eyes).&#x0D; Conclusions: Our study showed that MPCPC offers good IOP-lowering efficacy and patient tolerability in the treatment of refractory glaucoma. Larger, prospective, comparative studies are needed to determine a standardized MPCPC treatment protocol with high success and low complication rates.

Micropulse trans-scleral cyclophotocoagulation: a light before the end of the tunnel

Micropulse trans-scleral cyclophotocoagulation: a light before the end of the tunnel

Транссклеральная циклофотокоагуляция в микроимпульсном режиме в лечении начальной первичной открытоугольной глаукомы

Транссклеральная циклофотокоагуляция в микроимпульсном режиме в лечении начальной первичной открытоугольной глаукомы

EFFICACY AND SAFETY OF MICROPULSE TRANSSCERAL DIODE CYCLOPHOTOCOAGULATION IN PATIENTS WITH GLAUCOMA

• Glaucoma is the leading cause of irreversible blindness in the world, with approximately 8.4 million people blind from glaucomaSlowing disease progression and preservation of quality of life are the main goals for glaucoma treatment.• The only applied proven method to treat glaucoma is the reduction of intraocular pressure• Current glaucoma therapies include topical and systemic drugs, laser surgery, invasive glaucoma surgeries.• The new Micropulse Trans scleral Cyclophotocoagulation (MPTSCPC) is a non-incisional, noninvasive LASER treatment for glaucomaThe micropulse delivery mode includes on and cycles, allowing energy to build up in the targeted pigmented tissues, eventually reaching the coagulative threshold. The adjacent non-pigmented structures have time to cool during the off cycle, thus never reaching the coagulative threshold, which minimizes collateral tissue damageAim of workThe aim of this study is to evaluate the efficacy and safety of contact transscleral micropulse diode cyclophotocoagulation in patients with glaucoma.

Comparison of Glaucoma Drainage Device Versus Transscleral Cyclophotocoagulation for Secondary Glaucoma Following Ocular Surface Stem Cell Transplantation.

Rates of ocular surface failure and glaucoma reoperation were similar between cyclophotocoagulation (CPC) and glaucoma drainage devices (GDDs). CPC is a safe option in the management of secondary glaucoma after ocular surface stem cell transplantation (OSST). To assess surgical and ocular surface outcomes in patients requiring glaucoma surgery after OSST. Retrospective chart review of eyes with previous OSST that underwent either transscleral CPC or implantation of a GDD. Primary outcomes were ocular surface failure (defined as recurrence of corneal conjunctivalization with late fluorescein staining) and glaucoma surgery failure (defined as the need for additional glaucoma surgery, including repeat treatment or revision). Secondary outcomes were changes in intraocular pressure (IOP) and number of glaucoma medications. Additional subgroup analysis was performed for subtypes of CPC and GDD. Thirty-six glaucoma surgeries (7 Ahmed, 19 Baerveldt, and 10 CPC) were performed in 31 eyes with a history of prior OSST. The ocular surface failure rate was 19% for GDDs and 10% for CPC (P=0.65). Additional glaucoma surgery was needed for 38% of GDDs and 70% of CPC (P=0.14). The mean IOP reduction was 50% for GDDs and 28% for CPC (P=0.05). The mean drop reduction was 1.6 for GDDs and 0.1 for CPC (P=0.02). All glaucoma failures in the GDD group were related to tube erosion and/or hypotony, whereas all glaucoma failures in the CPC group were because of uncontrolled IOP. There were no significant differences in primary or secondary outcomes between CPC or GDD subgroups. Glaucoma is a frequent comorbidity in patients with severe ocular surface disease, and treatment poses unique challenges in those with prior OSST. In this study, ocular surface failure and glaucoma reoperation rates were similar between CPC and GDD groups, suggesting that CPC, including repeat treatment, is a safe option for the management of secondary glaucoma after OSST. A multidisciplinary approach is recommended in the management of these complex eyes.

Clinical Efficacy and Safety Outcomes of Micropulse Transscleral Diode Cyclophotocoagulation in Patients With Advanced Glaucoma.

Micropulse transscleral cyclophotocoagulation (MPTCP) is only moderately effective in lowering intraocular pressure (IOP) and is useful as an adjunct procedure to other glaucoma surgeries. There was a small risk of loss of vision, prolonged hypotony, and phthisis bulbi. The aim of this study was to determine the efficacy and safety of a single MPTCP treatment for an Asian population with advanced glaucoma. This is a retrospective single-center study of 207 eyes (207 patients) with advanced glaucoma which underwent first-time MPTCP between January 1, 2008, and March 31, 2018. Success was defined as IOP of 6 to 21 mm Hg or ≥20% reduction in IOP without an increase in glaucoma medication from baseline, and without glaucoma reoperation. The IOP, best-corrected visual acuity, and number of glaucoma medications were also analyzed. The mean (SD) age was 64.9±16.9 years. The mean follow-up duration was 18.7±16.2 months. The rate of success at postoperative years 1 and 2 follow-up was 44.1% and 32.6%, respectively. The median survival time of MPTCP was 9.0 months and 85 (40.9%) eyes received reoperation. The mean IOP decreased from 31.5±12.0 mm Hg preoperatively to 22.1±10.3 and 23.8±11.8 mm Hg at postoperative years 1 and 2, respectively (P<0.0001). The mean number of glaucoma medications was reduced from 3.3±1.0 preoperatively to 2.6±1.1 and 2.4±1.1 at postoperative years 1 and 2, respectively (P<0.0001). Significant complications included prolonged hypotony [1 eye (0.5%)], phthisis bulbi [7 eyes (3.4%)], and best-corrected visual acuity reduction [29 eyes (13.9%)]. Single first-time MPTCP for advanced glaucoma eyes was moderately effective in lowering IOP but >50% failed by 1 year.

Retrospective analysis of paediatric glaucoma at a tertiary referral centre in Hong Kong.

To evaluate the epidemiological features, clinical interventions, and outcomes of paediatric glaucoma in Hong Kong. Retrospective chart review. Clinical data from the medical records of all patients under 18years of age diagnosed with glaucoma from January 2008 to December 2017 at a university-affiliated, tertiary referral centre were collected. The patients' demographics, etiological distribution, clinical interventions, and outcomes were analysed. A total of 33 subjects (53 eyes) were identified, 30 (49 eyes) of whom were Chinese. Primary glaucoma accounted for 21.2% of subjects, while 78.8% were diagnosed with secondary glaucoma. The most common subtype was juvenile-onset open angle glaucoma, followed by Sturge-Weber Syndrome related glaucoma. The most commonly performed surgical interventions were tube-shunt surgery (Ahmed Glaucoma Valve) and transscleral cyclophotocoagulation. Most eyes had significant reduction in intraocular pressure after medical or surgical intervention, but deterioration of visual acuity remained common. Most cases of childhood glaucoma in Hong Kong are secondary rather than primary, similar to other regions with low incidence of parental consanguinity. The large proportion of secondary glaucoma which generally has poorer prognosis, is reflected by the frequency of multiple surgery, and a high incidence of visual deterioration despite significant intraocular pressure reduction in most eyes.

Individualized transscleral cyclophotocoagulation as the initial surgical intervention for medically uncontrolled glaucoma after blunt trauma.

To investigate the safety and feasibility of individualized transscleral cyclophotocoagulation (TSCPC) as the initial non-incisional surgical intervention for medically uncontrolled glaucoma after blunt trauma. The therapy records were reviewed of medically uncontrolled traumatic glaucoma after blunt trauma treated with TSCPC in a single hospital between January 2014 and December 2018. Thirty-one patients (31 eyes) received individualized TSCPC after ultrasound biomicroscopy and gonioscopy examination to localize and quantify the injured quadrants of the anterior chamber angle. In addition to the number of IOP lowing drugs, visual acuity (VA), IOP, inflammation and hemorrhage in the anterior chamber were analyzed at 1 day, 3 weeks and 3 months after operation, respectively. Success was defined as the IOP was not more than 21 mmHg. Compared with the data of pre-operation, constituent ratio of VA had no significant difference at 3 weeks (χ2 = 0.56, p > 0.75). At 3 months the average IOP was 22.2 ± 6.8 mmHg, which was significantly lower than that of pre-operation (46.6 ± 5.6 mmHg) (t = 19.818, p < 0.001). No IOP lowing drug was needed in 12 eyes, and more than three kinds of drugs were still needed in five eyes. The average number of medications decreased to 1.2 ± 1.2 (χ2 = 93.496, p < 0.001). The complete success rate was 38.7% and the relative success rate (combined with no more than two kinds of drugs) was 83.9% at 3 months. Individualized TSCPC could be applied as an initial non-incisional surgical intervention to treat traumatic glaucoma refractory to the medicine therapy.

Ultrasound cyclo plasty for the management of refractory glaucoma in chinese patients: a before-after study.

Cyclocryotherapy and transscleral cyclophotocoagulation are commonly used procedures for the treatment of refractory glaucoma, but still with many complications. Ultrasound cyclo plasty (UCP) is a novel technique that determines a selective and more precise coagulation necrosis of the ciliary body to reduce intraocular pressure (IOP), but its efficacy and safety have been less investigated in Chinese population. This study aimed to evaluate the clinical efficacy and safety of UCP in Chinese patients with refractory glaucoma. We designed a prospective, before-after study involving 36 eyes of 36 patients with refractory glaucoma that underwent uneventful UCP. Mean IOP, mean IOP reduction and subjective pain scale scores before and after UCP were compared to evaluate the efficacy of UCP in these patients. Procedural success defined as no abnormality of the treatment sites, and complications were recorded, along with confirmation of the safety of UCP. The 36 UCP patients had a mean IOP of 53.61 ± 12.4mmHg and a mean VAS score of 5.69 ± 3.02 preoperatively. Successful operation was achieved in 28 patients, with a success rate of 77.8%. In the follow-up observation at day 1, day 7, and month 1, 2, 3 and 6 postoperatively, both mean IOP and mean VAS score were significantly lower than those before operation (both P < 0.0001). The median baseline IOP reduction ranged from 22 to 36%. The mean reduction was 42.5% in 36 patients when taking IOP at the last follow-up visit as the last. No significant changes in visual acuity were achieved in 4 patients after UCP, and no adverse outcomes were present in other patients after timely treatment of complications such as conjunctival hyperemia, subconjunctival hemorrhage, or hyphema. UCP is a novel yet reliable option for Chinese patients with refractory glaucoma since its high efficacy and safety.

Case report \u2013 Acute Corneal Subepithelial Hydrops (ACSH) during Micropulse Transscleral Cyclophotocoagulation (MPTSC)

BackgroundTo present an unusual intra-operative complication of micropulse transscleral cyclophotocoagulation (MPTSC).Case presentationA 72-year old Chinese gentleman, who had primary angle closure glaucoma and had received bilateral laser iridotomy, presented with progressive left eye blurred vision (visual acuity of 20/40 OD and 20/200 OS). Examination reviewed left eye central retinal venous occlusion. The intraocular pressure (IOP) was 19 mmHg OS and was on maximally tolerated topical medications. Four weeks later, the left eye was complication by neovascular glaucoma; the IOP was raised to 26 mmHg despite additional oral acetazolamide and remained elevated after pan-retinal photocoagulation as well as cataract extraction by phacoemulsification. MPTSC was performed 8 days after the phacoemulsification. During the procedure, a sudden protrusion was formed on the corneal surface. On-table examination with operating microscope and portable slit-lamp reviewed an intact corneal epithelium with a globular-shaped collection of fluid at the subepithelial layer – acute corneal subepithelial hydrops (ACSH). The anterior chamber was formed and the globe was intact. After approximately 10–15 minutes, the swelling spontaneously ruptured and became a corneal epithelial defect. The defect healed on the tenth day after the event with conservative management. There was no irreversible corneal damage and the patient subsequently underwent a successful second MPTSC of the left eye because of poorly controlled IOP.ConclusionACSH is a possible intra-operative complication of MPTSC. We have proposed the possible mechanisms of ACSH. It is best to exercise caution when using MPTSC shortly after any incisional intraocular surgery.

Combined vitrectomy, near-confluent panretinal endolaser, bevacizumab and cyclophotocoagulation for neovascular glaucoma - a retrospective interventional case series.

Background: Neovascular glaucoma (NVG) is a severe, potentially blinding disease and a therapeutic challenge. The purpose of this study was to evaluate the safety and efficacy of an integrative surgical approach to neovascular glaucoma. Methods: Retrospective analysis of a one-year follow-up of a consecutive interventional case series of NVG. Eyes underwent transscleral cyclophotocoagulation, pars plana vitrectomy, near-confluent panretinal photocoagulation, and intravitreal bevacizumab. Phakic eyes underwent concomitant cataract surgery. Best-corrected visual acuity (BCVA, logMAR), intraocular pressure (IOP, mmHg), number of glaucoma medication, visual analog pain scale (VAPS, 0-10) were recorded at baseline, and 1, 3, 6, and 12 months. Blind eyes were excluded. Results: Seventy-seven eyes of 77 patients (45 male, 32 female, mean age 73.6±12.2 years) were included. NVG underlying conditions included retinal vein occlusion (41.6%), proliferative diabetic retinopathy (35.1%), central retinal artery occlusion (19.5%), and ocular ischemic syndrome (3.9%). Mean IOP decreased postoperatively from 46.3±10.1 mmHg to 14.5±7.9 mmHg (p<0.001), glaucoma medication from 4.7±1.3 to 1.8±1.8 (p<0.001), and VAPS from 6.0±1.8 to 0. BCVA remained unchanged. Postoperative intraocular inflammation had resolved in all eyes at the one-month follow-up. 71.4% (55/77) eyes did not require additional major interventions during follow-up. Conclusions: A single, comprehensive surgery session lowered IOP significantly, reduced GMS, and controlled pain.