Transscleral Cyclophotocoagulation Research Articles

Subcyclo laser procedure results in patients with glaucoma

Purpose. To analyse the results of subCyclo (subliminal transscleral cyclophotocoagulation) laser procedure for patients with glaucoma. Material and methods. The study included 50 eyes of 32 patients diagnosed with various subtypes of glaucoma for which we performed subliminal transscleral cyclophotocoagulation under retrobulbar anesthesia. After the procedure, all patients were advised to continue their antiglaucoma medication until further notice and we added a topical steroid for 2 weeks. The minimum follow-up period was 6 months. Results. The mean IOP (intraocular pressure) decreased from the preoperative value of 26.27 mmHg (±6.52) to 15.9 mmHg (±5.72) one day after the treatment. At 7 days, the average IOP was 13.72 mmHg (±4.31), 15.81 mmHg (±3.69) at 6 weeks, 15.94 mmHg (±5.66) at 3 months and 16.32 mmHg (±5.24) at 6 months. The second intervention was performed in 9 eyes due to poor IOP control after the first procedure, two eyes developed ocular hypertonia 6-8 hours after the procedure and one eye presented mydriasis after the procedure. Conclusions. Early results for this study showed that subCyclo laser procedure could determine a satisfactory decrease of the IOP with a low risk of complications. Abbreviations: IOP = intraocular pressure, TSCPC = transscleral cyclophotocoagulation, POAG = primary open-angle glaucoma, NVG = neovascular glaucoma, BCVA = best corrected visual acuity.

Randomized comparative trial of diode laser transscleral cyclophotocoagulation versus Ahmed glaucoma valve for neovascular glaucoma in Chinese - a pilot study.

PurposeThis is a pilot study to compare the effectiveness and safety of diode laser transscleral cyclophotocoagulation (TSCP) with the Ahmed glaucoma valve (AGV) in the management of neovascular glaucoma (NVG).MethodsEyes with NVG and an IOP greater than 21 mmHg on maximal medications, without previous glaucoma surgery or cyclodestruction, were randomized for either TSCP or AGV implantation. These eyes were followed for at least 6 months and analyzed with respect to their visual outcome, IOP, number of glaucoma medications required, and related complications.ResultsTwenty eyes (eight TSCP and 12 AGV) of 19 subjects with a follow-up duration of greater than 6 months were recruited. Mean follow-up duration was 28.5±17.9 and 31.0±15.4 months for the TSCP and AGV groups, respectively (P=0.80). IOP was successfully controlled in 86% of the eyes for both interventions. By including preservation or improvement of visual acuity as additional criteria for overall success, success decreased to 63% for TSCP and 42% for AGV, although the difference was not statistically significant (P=0.65). Eyes that had TSCP had fewer complications and required less subsequent procedures, compared to those that underwent AGV implantation.ConclusionBoth procedures were equally effective in controlling the IOP and reducing glaucoma medications in NVG. However, eyes with AGV implant tended to have higher rates of visual loss and complications, as well as requiring more postoperative procedures, than eyes that were treated with TSCP, although the difference was not statistically significant.

Efficacy of 180° Cyclodiode Transscleral Photocoagulation for Refractory Glaucoma

Objectives:To evaluate the efficacy and safety of transscleral cyclophotocoagulation (TS-CPC) limited to 180° of ciliary body ablation in patients with various forms of refractory glaucoma.Materials and Methods:Thirty eyes with refractory glaucoma treated with 180° TS-CPC were retrospectively analyzed for intraocular pressure (IOP) reduction and success rates. Patients’ age, gender, type of glaucoma, number of diode laser treatment sessions, postoperative complications, number of hypotensive medications required to control IOP, and best corrected visual acuity (BCVA) were evaluated. The criteria for success were defined as postoperative IOP <21 mmHg or >20% decrease in IOP with or without additional medical treatment.Results:The mean age of all patients was 51.3±26.9 years (range,1-84 years). The mean postoperative IOP level (23.9±8.5 mmHg) was significantly lower than preoperative IOP (39.2±8.9 mmHg) (p<0.001). The success rate was 66.6% after the first laser treatment and reached 86.7% following repeat laser treatments over an average follow-up period of 22.2±19.9 months. The need for topical hypotensive medications decreased from 2.8±1.0 preoperatively to 2.4±1.3 following TS-CPC (p=0.048). Two patients (6.6%) had a one-line decrease in their BCVA following TS-CPC. Transient hypotony and hyphema developed in 4 patients (13.3%). Total laser energy delivered did not correlate with either preoperative (rho=0.10; p=0.594) or postoperative IOP (rho=0.21; p=0.260).Conclusion:TS-CPC limited to 180° of ciliary body ablation is associated with a reasonable success rate and low incidence of adverse effects in patients with refractory glaucoma.

Efficacy and safety of Micropulse® transscleral cyclophotocoagulation in glaucoma

Abstract Objective To report the results using Micropulse® transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. Methods Retrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse®. The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5 ms (31.3%) of active cycle. Results A total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180 s. Definition of success: 5 mmHg The overall success rate was 72.7% in the first month, 54% at 4 months, 41% at 6 months, and 27.3% at final follow-up. Patients with longer treatment durations (180 s) achieved better results. The mean reduction in IOP in successful eyes was 36% (from 26.3 to 16.7 mmHg, SD 4.58, p = 0.028). No complications were reported. Conclusions In a heterogeneous population of glaucoma (mostly congenital and pseudoexfoliation types), a low success rate (27.3%) was obtained in the medium-term with a single session of Micropulse®.

Eficacia y seguridad de la ciclofotocoagulación transescleral con micropulsos en el tratamiento del glaucoma

ObjectiveTo report the results using Micropulse® transscleral cyclophotocoagulation (Iridex) in the treatment of glaucoma. MethodsRetrospective study in adult patients with glaucoma with at least 6 months of follow-up, and only one session of Micropulse®. The same surgical technique was used in all cases. The only laser parameter that could vary was the total treatment duration (in seconds). The remaining parameters were fixed at 2 Watts of power and 0.5ms (31.3%) of active cycle. ResultsA total of 22 eyes of 17 patients with glaucoma of various types and stages were included (mainly congenital and pseudoexfoliation). The mean follow-up time was 7.9 months. The total treatment duration varied from 100 to 180seconds.Definition of success: 5mmHg <Intraocular pressure (IOP)<21mmHg and a reduction of ≥20% of the baseline value and no addition of oral carbonic anhydrase inhibitors, and no re-operation.The overall success rate was 72.7% in the first month, 54% at 4 months, 41% at 6 months, and 27.3% at final follow-up. Patients with longer treatment durations (180s) achieved better results. The mean reduction in IOP in successful eyes was 36% (from 26.3 to 16.7mmHg, SD 4.58, P=.028). No complications were reported. ConclusionsIn a heterogeneous population of glaucoma (mostly congenital and pseudoexfoliation types), a low success rate (27.3%) was obtained in the medium-term with a single session of Micropulse®.

Safety and Efficacy of Diode Laser Transscleral Cyclophotocoagulation in Eyes With Good Visual Acuity.

The main aim of this study was to evaluate the safety and efficacy of diode laser transscleral cyclophotocoagulation (TSCPC) in eyes with good visual acuity. A retrospective chart review identified patients who underwent TSCPC for uncontrolled intraocular pressure (IOP) from 2014 to 2016. Enrollment criteria included pretreatment best-corrected visual acuity (BCVA) of 20 of 40 or better, and a minimum of 6 months of postoperative follow-up. Thirty-three eyes of 33 patients(mean age, 72.1±16.0 y) were enrolled (mean follow-up 12.6±6.1 mo). The mean (SD) IOP was reduced 48.3% from 27.1 mm Hg (7.8) at baseline to 13.1 mm Hg (4.2) at last follow-up. Reduction of ≥1 glaucoma medications was achieved in 17 eyes (51.5%) at last follow-up. The cumulative probability of complete success (BCVA loss <2 Snelling lines, 20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 78.8% and 50% at months 6 and 12, respectively. The cumulative probability of qualified success (BCVA≥2 lines with ≥20% reduction IOP, no reoperation for glaucoma, no IOP<5 mm Hg) was 90.1% and 81.3% at month 6 and 1 year, respectively. Significant vision loss, defined as BCVA≥2 lines, occurred in 33% of patients. The most common complications were postoperative iritic (56.3%) and cystoid macular edema (12.5%). TSCPC demonstrates a strong reduction in IOP and glaucoma medication use. However, with significant vision loss in 33% of patients, future prospective studies with a comparison group receiving traditional glaucoma surgery are needed to determine comparative safety and efficacy.

Micropulse Versus Continuous Wave Transscleral Cyclophotocoagulation in Refractory Pediatric Glaucoma.

The aim of this study was to compare the safety and efficacy of micropulse cyclophotocoagulation (MP-CPC) and transscleral continuous wave cyclophotocoagulation (CW-CPC) for the treatment of refractory glaucoma in the pediatric age group. This prospective study included 45 eyes of 36 children requiring transscleral cyclophotocoagulation, in the period spanning from September 2016 to August 2017, using micropulse (MP-CPC) or continuous wave (CW-CPC) modes. The intraocular pressure (IOP) reduction, success rates, and complications were compared for both groups. Success was defined as an IOP of 5 to 21 mm Hg, in the absence of vision-threatening complications at 6 months. The MP-CPC group included 17 eyes, in patients aged 67.8±48 months, and the CW-CPC group included 28 eyes, in patients aged 61.3±38.3 months. There was a tendency toward lower IOP in the MP-CPC group at all follow-ups, almost reaching statistical significance at 2 weeks and 3 months (P=0.05). IOP reduction was 63% in the MP-CPC group and 67% in the CW-CPC group (P=0.6). The success rate was higher in the MP-CPC group (71% vs. 46% in the CW-CPC group), but the difference was not significant (P=0.1). No significant complications were noted in the MP-CPC group whereas, in the CW-CPC group, 1 eye developed phthisis bulbi, and 2 eyes had severe pain and uveitis (P=0.3). Both the MP-CPC and CW-CPC are effective in lowering the IOP in children with refractory glaucoma. However, the rate of complications, pain, and inflammation seem to be lower with the micropulse mode, making it a safer alternative for cyclophotocoagulation, especially since retreatments are often needed.

Patient Outcomes Following Micropulse Transscleral Cyclophotocoagulation: Intermediate-term Results.

To report the safety and efficacy outcomes following micropulse transscleral cyclophotocoagulation (MPTSCPC) procedure in patients with uncontrolled glaucoma. Longitudinal retrospective cohort, multicenter study. Patients with different types of glaucoma who underwent MPTSCPC with P3 probe between July 2015 and May 2017. Patients were treated by different glaucoma specialists from 5 different locations (Tulane Study Group). Data on preoperative characteristics, surgical procedure(s) performed, and postoperative outcomes were collected and analyzed. Statistical analysis using logistic regression and Kaplan-Meier analysis was performed with Stata software. Intraoperative and postoperative complications, intraocular pressure, visual acuity, need for incisional glaucoma surgery, need for repeat micropulse, and number of topical medications were studied. One hundred ninety-seven eyes from 161 patients were included. Median follow-up was 12 months [interquartile range (IQR), 6 to 14]. Glaucoma diagnosis included 141 primary open-angle glaucoma (POAG), 8 neovascular glaucoma, and 12 others. The total success rate was 71%. Two percent (4 patients) developed postoperative cystoid macular edema. Preoperative mean intraocular pressure (SD) was 22±9 and 16±6 mm Hg at last follow-up (P<0.001). Median preoperative logMAR visual acuity (IQR) was 0.4 (0.2 to 1.0) and 0.3 (0.2 to 1.0) at last follow-up (P=0.65, Wilcoxon signed-rank test). Median number (IQR) of topical medications was 3 (1 to 4) preoperative and 2 (1 to 3) at last follow-up (P<0.001). Kaplan-Meier analysis indicated 90% of patients free from repeat MPTSCPC at 12 months. Multivariable logistic regression identified 3 significant independent predictors of total success: diagnosis (P=0.011) (POAG), previous glaucoma surgery (P=0.003), and other concurrent procedures (P=0.013). Our large longitudinal cohort study has provided evidence that MPTSCPC is a safe and generally effective option in the treatment of POAG up to 12 months.

Transscleral Diode Laser Cyclophotocoagulation: A Comparison of Slow Coagulation and Standard Coagulation Techniques

To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Retrospective case series. This study included 78 eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. This study compared 52 eyes treated with slow coagulation TSCPC to 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings and outcomes were assessed. The main outcome measures were visual acuity (VA), intraocular pressure (IOP) and post-surgical complications. The initial LogMAR VA was 1.94 (0.73) [mean (SD)] in the slow coagulation TSCPC group and 1.71 (0.90) in the standard TSCPC group (p=0.507). Initial IOP was 37 (13) mm Hg in the slow coagulation group and 39 (13) mm Hg in the standard group (p=0.297). The follow-up periods were 16.36 months and 24.68 months for the slow coagulation and standard groups (p=0.124). VA remained better than light-perception in 71.1% of slow coagulation treated patients and 65.0% of standard TSCPC treated patients (p=0.599). IOP remained below 20 mm Hg in 46% of slow coagulation treated patients and 44% of standard TSCPC treated patients (p=0.870). The mean number of complications was higher in the standard group [1.46 (1.24)] versus the slow coagulation group [0.62 (0.75)] (p=0.002). The incidence of the need for a second procedure (slow coagulation- 28.8%, standard- 23.1%, p=0.588) and maximum number of medications needed to control IOP postoperatively (p=0.771) were similar between the two groups. In this case series, slow coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques were also comparable, although standard TSCPC had a higher incidence of prolonged inflammation postoperatively. This study suggests that slow coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged post-operative inflammation-a feared complication of TSCPC-when compared to standard "pop-titrated" TSCPC.

Comparison on the efficacy of transscleral cyclophotocoagulation with two different laser parameters

Objective To compare the efficacy of transscleral cyclophotocoagulation with two different laser parameters. Methods The data of 59 eyes of 59 cases with glaucoma from Feb. 2016 to Feb. 2017, who underwent transscleral cyclophotocoagulation were analyzed retrospectively. All cases were divided into two groups randomly. Group A used lower power with longer pulse time and group B used normal parameters. Intraocular pressures (IOP), best-corrected visual acuity (BCVA), anti-glaucoma medications usage and complications were observed and compared between the two groups. Results The baselines of the two groups were similar. The surgical success was defined as IOP between 6 and 21 mmHg (1 mmHg=0.133 kPa), or at least 30% reduction. Group A, 28 cases were followed up for (11.2±0.5) months and the final success rate was 80.0%. Group B, 31 cases were followed up for (11.1±0.5) months and the final success rate was 78.6%. The difference of success rate was not significant between the two groups (χ2=0.017, P=0.895). The BCVA was 0.53±0.44 (logMAR) in group A, which was better than 0.67±0.57 in group B (t=-2.240, P=0.029). At final follow-up time, the kinds of anti-glaucoma medications were 1.1±0.7 in group A and 1.2±0.8 in group B. The difference was not significant between the two groups (t=-0.480, P=0.634). The valuations for pain were more mild in group A than those in group B (χ2=10.510, P=0.005). The differences in other complications were not significant between the two groups. Conclusion Compared with conventional diameters, transscleral cyclophotocoagulation with lower power and longer pulse time may reduce IOP similarly with better visual acuity and fewer complications. Key words: Cyclophotocoagulation, transsclera; Intraocular pressure; Glaucoma

High intensity focused ultrasound cyclodestruction versus cyclodiode treatment of refractory glaucoma: A retrospective comparative study

To compare the efficacy of two cyclodestructive treatments for refractory glaucoma: High Intensity Focused Ultrasound (HIFU) cyclocoagulation and transscleral diode laser cyclophotocoagulation (cyclodiode). A retrospective comparative single centre study including all patients who underwent cyclodestruction for refractory glaucoma by either HIFU cyclocoagulation or cyclodiode. "Refractory glaucoma" was defined as an uncontrolled high IOP despite medical treatment and at least one filtering surgery. Uncontrolled high IOP was defined as an IOP≥16mmHg. The diagnosis of glaucoma was confirmed by automated visual field (VF) testing and peripapillary RNFL scans using a time-domain ocular coherence tomography device. Treatment success was defined as: postoperative IOP between 5mmHg and 21mmHg and IOP reduction greater than or equal to 20% as compared to preoperative values. Among the 99 eyes of 86 patients included in this study, 29 eyes were treated by cyclodiode and 70 eyes by HIFU. Median follow-up was 3 months (IQR 3-6) for the cyclodiode group and 6 months (IQR 3-8) for the HIFU group. Average preoperative intraocular pressure (IOP) was 34.3±11.1mmHg (cyclodiode group) and 23±6.8mmHg (HIFU group). The treatment success rate at last follow-up was 52% [34-70] for the cyclodiode group and 25% [15-35] for the HIFU group (P value=0.01). Kaplan-Meier survival analysis showed that the mean estimated time to failure was 5.9 months (4.4-7.5) for the cyclodiode group and 3.7 months (2.8-4.7) for the HIFU group (log-Rank test, P=0.02). A 2-line visual acuity loss was observed for 31% of the patients treated by cyclodiode and 17% for those treated by HIFU. In the cyclodiode group 4 cases of hypotony were reported vs. none in the HIFU group. The success rate was significantly higher for cyclodiode treatment as compared to HIFU cyclodestruction when treating refractory glaucoma. However, significantly fewer complications were observed with HIFU cyclocoagulation as compared to cyclodiode.

Laser Management of Glaucoma in Exfoliation Syndrome.

Argon laser trabeculoplasty as well as selective laser trabeculoplasty can be used in patients with exfoliation syndrome with similar safety and efficacy. However, treatment effect may abruptly reverse and patients need to be followed regularly to monitor intraocular pressure control. Newer laser treatment modalities including micropulse laser trabeculoplasty, titanium sapphire laser trabeculoplasty and pattern scanning trabeculoplasty show promising results but need to be studied in exfoliation patients. For exfoliation patients with angle closure, peripheral iridectomy, iridoplasty or cataract extraction can be very helpful. For refractory exfoliation glaucoma, transscleral diode laser cyclophotocoagulation offers a reasonable option to lower intraocular pressure. Other approaches to cyclophotocoagulation such as micropulse transcleral diode laser need to be studied further in exfoliation patients.

Safety and effectiveness of primary transscleral diode laser cyclophotoablation for glaucoma in Nigeria

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.

Choroidal thickness increase after micropulse transscleral cyclophotocoagulation

Glaucoma, the affliction that results in optic nerve damage and vision loss, is the main cause of irreversible blindness. The goal of this study was to describe our experience and OCT findings regarding glaucoma patients who underwent MicroPulse Transscleral Cyclophotocoagulation. A variety of glaucoma patients treated with MP-TSCPC were included in our study. LASER settings were 2000mW of 810nm infrared diode micropulse LASER, 31.3% duty cycle and the duration of treatment was between 80-130 s per hemisphere to each eye, at 3 mm of corneoscleral limbus, spearing the nasal and temporal clock hours and also the region with previous filtration surgeries (trabeculectomy). We conducted a prospective study in which twenty-two patients underwent MP-TSCPC under local anaesthesia and they were examined one week, one month, three months, and six months postoperatively. Mean IOP dropped from 35.23 mmHg preoperatively to 17.73mmHg (49.67%) at 1 week follow-up, to 21.81 mmHg (38.09%) at 1 month follow-up, to 22.34 mmHg at 3 months follow-up and to 23.56 mmHg at 6 months follow-up. Four patients (15.8%) underwent a second treatment (at 1 month after the initial treatment) due to insufficient IOP decrease, two of them with success in lowering the IOP postoperatively. By measuring the foveolar choroidal thickness via macular OCT scan, we noticed that all responsive patients had a thicker choroid one week after the laser treatment, with a steady increase of a mean 7.3% that was sustained at one and three months follow-up, while in non-responsive patients, the choroidal thickness remained the same postoperatively, or had a significant decrease. The increase in choroidal thickness in all patients in whom we observed IOP reduction was a significant correlation that supported the mechanism of increased uveoscleral outflow obtained from LASER treatment.

Comparison of the safety and efficacy of triple sequential therapy and transscleral cyclophotocoagulation for neovascular glaucoma in the angle-closure stage

To compare the efficacy and safety of triple therapy combining intravitreal injection of anti-vascular endothelial growth factor, trabeculectomy, and pan-retinal photocoagulation via binocular indirect ophthalmoscopy, with that of transscleral cyclophotocoagulation (TCP) to treat neovascular glaucoma in the angle-closure stage. Eighteen triple therapy patients and 25 TCP patients between May 2014 and May 2016 were retrospectively analysed. Anterior chamber puncture and anti-VEGF intravitreal injection were performed on the first day of sequential therapy. Trabeculectomy was performed 3–5 d after injection; pan-retinal laser photocoagulation via binocular indirect ophthalmoscopy was initiated 5–7 d later. The IOP of the triple therapy group was lower than that of the TCP group (15.2 ± 2.2 vs. 20.0 ± 8.5 mmHg) and fewer anti-glaucoma drugs were used (0.5 ± 1.0 vs. 0.6 ± 1.0) after treatment. The success rates of the two groups were 89% and 60% respectively (P = 0.032). The visual function of 94% of triple therapy patients was preserved or improved compared to 64% of TCP patients with statistical significance (P = 0.028). No patient in the triple therapy group showed hypotony or eyeball atrophy. Compared to TCP, triple therapy shows higher success rate, fewer complications, and attributes to visual function preservation.

Clinical Efficacy and Safety Profile of Micropulse Transscleral Cyclophotocoagulation in Refractory Glaucoma

To investigate the clinical efficacy and safety profile of micropulse transscleral cyclophotocoagulation (MP-CPC) in patients with refractory glaucoma. Retrospective case series of 79 consecutive patients who underwent MP-CPC at the Wills Eye Hospital from March 23, 2014 to June 23, 2016 and who had at least 3 months of follow-up. Treatment success was defined as an intraocular pressure (IOP) of 6 to 21 mm Hg or a reduction of IOP by 20%. Failure was defined as an inability to meet the criteria for success, need for retreatment >3 times, or need for incisional glaucoma surgery. Patients had a mean follow-up time of 7.8±4.5 months. The mean IOP before MP-CPC was 31.9±10.2 mm Hg. The IOP was reduced by an average of 51% at the last follow-up and the mean number of IOP lowering medications was reduced from 2.3 at baseline to 1.5 at last follow-up. Treatment success rates were 75% at 3 months, 66% at 6 months, and 67% at last follow-up. Complications of MP-CPC included 7 patients with hypotony (8.8%), 21 patients with prolonged anterior chamber inflammation (1+ cell or flare for >3 mo, 26%), 13 patients with loss of ≥2 lines of best-corrected visual acuity at 3 months (17%), 4 patients with macular edema (5%), 2 patients with corneal edema and 2 patients with phthisis. MP-CPC is an effective treatment for patients with refractory glaucoma. Shorter treatment times with more frequent repeat treatments, if necessary, should be considered given the incidence of significant vision loss in this study.

Cyclodestructive procedures for non-refractory glaucoma.

Cyclodestructive procedures for non-refractory glaucoma.

Efficacy of transscleral laser cyclophotocoagulation for the treatment of refractory glaucoma

Objective To evaluate the efficacy of diode laser transscleral cyclophotocoagulation in the treatment of refractory glaucoma. Methods The data of 48 eyes of 48 refractory glaucoma patients were enrolled and analyzed retrospectively. All eyes underwent diode laser transscleral ciliary body photocoagulation. Postoperative intraocular pressure, visual acuity and complications were observed and recorded. Results The visual acuity improved in 4 patients (8.3%), decreased in 2 patients (4.2%), and kept no change in 42 cases(87.5%) postoperatively. The success rates of IOP at 1 , 3 and 6 months after operation were 58.3%, 66.7% and 81.3% respectively, and the total effective rates were 89.6%, 93.8% and 95.9% respectively. No atrophy of eyeball, sclera melted or other serious postoperative complication happened. Conclusion Diode laser transscleral cyclophotocoagulation is safe and effective for the treatment of refractory glaucoma. Key words: Laser, diode; Cyclophotocoagulation, transscleral; Glaucoma, refractory

Дистанционная термография наружной поверхности глаза у пациентов с абсолютной глаукомой при проведении транссклеральной лазерной коагуляции цилиарного тела (пилотное исследование)

Дистанционная термография наружной поверхности глаза у пациентов с абсолютной глаукомой при проведении транссклеральной лазерной коагуляции цилиарного тела (пилотное исследование)

Evolution of Cyclophotocoagulation.

Cyclodestructive techniques have been a treatment option for refractory glaucoma since its first use in the 1930s. Over the past nine decades, cyclodestruction has advanced from the initial cyclodiathermy to micropulse transscleral cyclophotocoagulation (MP-TSCPC) which is the current treatment available. Complications associated with cyclodestruction including pain, hyphema, vision loss, hypotony and phthisis have led ophthalmologists to shy away from these techniques when other glaucoma treatment options are available. Recent studies have shown encouraging clinical results with fewer complications following cyclophotocoagulation, contributing greatly to the current increase in the use of cyclophotocoagulation as primary treatment for glaucoma. We performed our literature search on Google Scholar Database, Pubmed, Web of Sciences and Cochrane Library databases published prior to September 2017 using keywords relevant to cyclodestruction, cyclophotocoagulation and treatment of refractory glaucoma.