Short-term outcomes of micropulse transscleral cyclophotocoagulation as a primary versus additional therapy in eyes with uncontrolled glaucoma

Purpose: To study the safety and efficacy outcomes of Micropulse Transscleral Cyclophotocoagulation (MP?TSCPC) as a primary versus additional therapy in eyes with uncontrolled glaucoma. Methods: This was a prospective, interventional, comparative study. All patients with advanced and refractory glaucoma treated with MP?TSCPC from April 2020 to December 2020 were recruited in this study. Results: A total of 77 eyes of 77 patients were analyzed. Group A (n = 33), included patients with advanced glaucoma at high risk for invasive surgery, who underwent MP?TSCPC as the primary intervention, and group B (n = 44) included patients who had undergone previous surgical intervention and MP?TSCPC was used additionally to control the intraocular pressure (IOP). Mean IOP and mean number of antiglaucoma medications were 34.06 (13.9) mmHg and 3.64 (0.7), respectively, in group A and 35.61 (11.5) mmHg and 3.73 (0.9), respectively, in Group B. Postoperatively, the mean IOP and percentage of IOP reduction were significantly lower at 1, 3, and 6 months, that is, 20.78 (32%), 22.07 (30%), and 19.09 (37%), respectively, in group A and 23.68 (35%), 19.50 (44%), and 19.61 (42%), respectively, in group B, but there was no difference between the groups at all visits. Postoperative need for ocular hypotensive drugs did not differ in group A (P = 0.231); however, it was significantly lower in group B (P = 0.027). Group A had 87%, 77%, and 74% success rates at 1, 3, and 6 months, respectively, whereas group B had 91%, 86%, and 77% success rates at 1, 3, and 6 months, respectively. Postoperative complications and intervention did not reveal any statistical difference between the two groups. Conclusion: MP?TSCPC may be considered as a temporizing measure both as a primary or as an additional intervention to control the IOP in eyes with refractory and advanced glaucoma that have a high risk of vision?threatening complications with invasive surgery.

The curative effect of endoscopic cyclophotocoagulation combined with trabeculectomy for primary open angle glaucoma / 中国医师进修杂志

Objective:To investigate the curative effect of endoscopic cyclophotocoagulation combined with trabeculectomy for primary open angle glaucoma.Methods:From January 2020 to May 2021, 30 eyes of 30 patients with advanced primary open angle glaucoma with cataract who underwent endoscopic cyclophotocoagulation combined with trabeculectomy in the Municipal Hospital Affiliated to Xuzhou Medical University were retrospectively analyzed. The preoperative best corrected visual acuity, preoperative intraocular pressure (IOP) and numbers of anti-glaucoma medication were recorded. IOP, numbers of anti-glaucoma medication at 1 day, 3 months, 6 months and 1 year after operation, postoperative complications, the numbers of absolute success and qualified success were recorded.Results:All cases were followed up for 1 year. The best corrected visual acuity improved by more than one line in 26 eyes at 1 year after operation. Preoperative visual acuity was maintained in 3 eyes visual acuity decreased in 1 eye. The IOP and numbers of anti-glaucoma medication at 1 day, 3 months, 6 months and 1 year after operation were significantly different from those before operation ( P<0.01). At 1 year after operation, 8 patients were qualified successful and 17 patients were absolutely successful. Early hyphema in 30 eyes, transient ocular hypertension in 3 eyes ciliary body detachment in 0 eyes, corneal edema in 9 eyes, and anterior chamber exudation in 8 eyes. Conclusions:In this small sample size of study with follow-up for 12 months, the results showed that endoscopic cyclophotocoagulation combined with trabeculectomy in the treatment of advanced open angle glaucoma has good preliminary efficacy and safety. However, a large sample of cases is still needed to further study its long-term safety and efficacy.

Efficacy and safety of subliminal transscleral cyclophotocoagulation in uncontrolled glaucoma

Purpose: To determine the efficacy of subliminal cyclophotocoagulation in reducing intraocular pressure (IOP) and to assess the safety profile of the procedure. Methods: We reviewed the charts of all patients who underwent subliminal cyclophotocoagulation between August 2019 and August 2020. The IOP, number of antiglaucoma medications, and visual acuity were compared at baseline and at 6 months. The post-laser complications were noted. Paired t-test, Wilcoxon rank-sum test, and McNemar test were used for analysis. Results: This study included 40 eyes of 40 patients. The most frequent diagnosis was neovascular glaucoma (55%), followed by primary open-angle glaucoma (17.5%). The mean IOP reduced from 32 to 21 mmHg (mean IOP reduction: 32%, 95% confidence interval [CI]: 27%–37%, P < 0.001). Mean number of antiglaucoma medications declined from 3.2 to 1.9 (P < 0.001). Use of oral acetazolamide decreased from 62% to 5% (P < 0.001). The success rate of the procedure at 6 months was 55%. One patient had unexplained visual acuity decline after the procedure. Conclusion: Subliminal sub-cyclophotocoagulation is effective in treating refractory glaucoma in the Indian population. It decreases the medication burden. However, subliminal lasers can also cause vision-threatening complications such as hypotony, uveitis, and optic nerve hypoperfusion. So, clinicians should be cautious when using sub-cyclophotocoagulation in patients with good vision.

Outcomes of Ahmed glaucoma valve and transscleral cyclophotocoagulation in neovascular glaucoma

Purpose: To determine the outcomes of Ahmed glaucoma valve (AGV) and transscleral diode cyclophotocoagulation (CPC) in neovascular glaucoma (NVG). Methods: This was a single?center retrospective comparative case series involving chart review of consecutive patients who underwent AGV or CPC for treatment of NVG and had ?6 months of follow?up. Surgical failure at 6 months, defined as an IOP of >21 or <6 mm Hg with hypotony maculopathy after 1 month, progression to no light perception (NLP) vision, glaucoma reoperation, or removal of AGV were the main outcome measures. Results: In total, 121 eyes of 121 patients were included (70 AGV and 51 CPC). Baseline demographics, visual acuity (VA), and intraocular pressure (IOP) were comparable between groups. At 6 months, failure was significantly higher in the CPC group than in the AGV group (43.1% vs. 17.1%, P = 0.020). Both groups had similar IOP and medication number at 6 months, but VA was significantly lower in the CPC group compared to the AGV group (2.4 � 0.8 vs. 1.9 � 1.0, P = 0.017). More CPC eyes required reoperation for glaucoma than AGV eyes (11.8% vs. 1.4%, P = 0.041). Multivariate regression analysis identified higher preoperative IOP (P = 0.001) and CPC surgery (P = 0.004) as independent predictors of surgical failure at 6 months. Age, sex, race, NVG etiology, bilaterality of the underlying retinal pathology, perioperative retina treatment, and prior or combined vitrectomy were not significant. Conclusion: AGV and CPC had comparable IOP and medication reduction in NVG eyes at 6 months. CPC was more frequently associated with failure, reoperation for glaucoma, and worse visual outcomes. High preoperative IOP and CPC surgery independently predicted surgical failure.

Comparison the curative effect of trans-scleral cyclophotocoagulation versus cyclocryotherapy in the treatment of absolute glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the effectiveness of diode transscleral cyclophotocoagulation(CPC)and transscleral cyclocryotherapy(CCT)for the intraocular pressure(IOP)control and postoperative complications of absolute glaucoma. <p>METHODS: This was a prospective case observation study. Totally 85 cases with absolute glaucoma which were admitted by Tianjin Eye Hospital were randomly assigned in 2 groups to receive either CPC or CCT. IOP, the numbers of anti-glaucoma medication, inflammatory reaction of anterior segment and postoperative ocular pain which was evaluated by Visual Analogue Scale(VAS)in two groups were recorded at eight points in time: the day before surgery and 1d, 3d, 1wk, 2wk, 1mo, 3mo and 6mo after surgery. The generalized estimated equation was used to compare all the indexes before and after operation and the difference of success rate between the two surgical methods. <p>RESULTS: Compared with CPC group, IOP of CCT group decreased less than that before surgery at 1, 3d, 1, 2wk, 1mo after surgery, VAS score decreased less than that before surgery at 3d, 1, 2wk, 1mo after surgery, and the number of anti-glaucoma drugs decreased less than that before surgery at 1, 3d, 1, 2wk after surgery(<i>P</i><0.05). Compared with CPC group, the complete success rate of CCT group was higher than that at 1d after surgery at 3d, 1, 2wk, 1, 3, 6mo after operation, but only the difference of 3, 6mo after surgery was statistically significant(<i>P</i><0.05). Compared with CPC group, anterior chamber flash grade of CCT group increased more than that before surgery at 3d, 1, 2wk, 1mo after surgery, conjunctival congestion grade increased more than that before surgery at 1, 3d, 1, 2wk after surgery, corneal edema grade increased more than that before surgery at 3d, 1, 2wk, 1mo after surgery(<i>P</i><0.05).<p>CONCLUSION: Compared with CPC, the rate of IOP reduction after CCT was slower, the inflammatory reaction of anterior segment and discomfort of eyeball were more severe and lasted longer. Therefore, the duration of anti-inflammatory drugs and anti-glaucoma medications should be extended after the surgery.

Clinical effects of phacoemulsification and intraocular lens implantation combined with endoscopic cyclophotocoagulation in the treatment of glaucoma with cataract / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To analyze the clinical value of phacoemulsification and intraocular lens implantation(Phaco+IOL)combined with endoscopic cyclophotocoagulation(ECP)in the treatment of patients with glaucoma and cataract. <p>METHODS: Between January and December 2019, 58 patients(64 eyes)with primary glaucoma and cataract diagnosed and treated in Ophthalmology Department of the hospital were enrolled in this study. According to the patients' and their family members' willingness, the study subjects were divided into ECP group(27 cases, 30 eyes, Phaco+IOL+ECP)and trabeculectomy(TRAB)group(31 cases, 34 eyes, Phaco+IOL+TRAB). Surgical results, changes in visual acuity, intraocular pressure, corneal endothelial cells, and optical coherence tomography(OCT)parameter were compared between the two groups. <p>RESULTS: The complete success rate of surgery in ECP group was 83%, higher than 59% in TRAB group(<i>P</i><0.05). After surgery, visual acuity of the two groups was improved, and intraocular pressure was reduced(<i>P</i><0.05), without statistical difference between groups(<i>P</i>>0.05). After surgery, the coefficient of variation of corneal endothelial area, proportion of hexagonal cells, average cellular area, and central corneal thickness of ECP group were lower and smaller than those of TRAB group, while corneal endothelial cell density was higher than TRAB group(<i>P</i><0.05). After surgery, anterior chamber depth(ACD), angular opening distance 500(AOD₅₀₀), trabecular iris angle(TIA), and angular recess area(ARA)were increased in the two groups(<i>P</i><0.05), without statistically significant differences between groups(<i>P</i>>0.05). The incidence of ocular hypertension requiring drug control and the total incidence of ocular hypertension were significantly lower in ECP group than in TRAB group(all <i>P</i><0.05). <p>CONCLUSION: Compared with TRAB, ECP can achieve a higher complete success rate in the treatment of glaucoma with cataract, with less influence on corneal cells.

Prospective evaluation of micropulse transscleral diode cyclophotocoagulation in refractory glaucoma: 1 year results / Avaliação prospectiva do laser de diodo micropulsado em pacientes com glaucoma refratário: resultados de um ano de seguimento

ABSTRACT Purpose: To evaluate the effectiveness in in­traocular pressure reduction and safety of micropulse trans­scleral diode cyclophotocoagulation in refractory glaucoma. Methods: We prospectively evaluated a case series of 21 eyes of 21 consecutive patients with refractory glaucoma treated with micropulse transscleral diode cyclophotocoagulation at 12-month follow-up. The total treatment time was at the discretion of the surgeon, considering baseline and target intraocular pressure and glaucoma diagnosis. Intraocular pressure, inflammation, visual acuity, and number of medications were monitored. Success was defined as intraocular pressure between 6 and 21 mmHg and/or 30% reduction from baseline intraocular pressure with or without the use of antiglaucoma medications. Visual acuity loss was defined as a loss of ≥2 lines of vision on the Snellen chart or a ≥2-level decrease in visual function in patients with nonmeasurable chart acuity. Results: The mean age was 61.04 ± 12.99 years, and 11 (52.4%) patients were male, with most (95%) patients showing low visual acuity at baseline (count fingers or worse). The mean intraocular pressure was 33.38 ± 15.95 mmHg, and the mean number of medications was 3.5 ± 1.1 at baseline. After 1, 3, 6, and 12 months, 76.19%, 57.14%, 55.56%, and 66.67%, respectively, of the patients were classified as treatment successes. Seven (33.3%) patients required new laser treatment and were considered treatment failures. The mean intraocular pressure reduction was 44.72% ± 29.72% in the first week and 41.59% ± 18.93% at the end of follow-up (p=0.006). The mean number of medications significantly dropped to 2.00 ± 1.7 at the 12-month visit (p=0.044). Complications included hypotony (4.8%), intraocular inflammation after 1 month (19%), and visual acuity loss (4.8%). Conclusions: Micropulse transscleral diode cyclophotocoagulation was safe and effective for reducing intraocular pressure in eyes with refractory and advanced glaucoma, with reduced need for ocular antihypertensive medication.

RESUMO Objetivo: Avaliar a eficácia na redução da pressão intraocular e na segurança da ciclofotocoagulação com laser de diodo transescleral em glaucoma refratário. Métodos: Avaliamos prospectivamente uma série de casos de 21 olhos de 21 pacientes com glaucoma refratário tratados com ciclofotocoagulação com laser de diodo transescleral com acompanhamento por 12 meses. O tempo total de tratamento ficou a critério do cirurgião, considerando a pressão intraocular inicial e alvo e o tipo de glaucoma. Pressão intraocular, inflamação, acuidade visual e número de medicamentos foram monitorados. O sucesso foi definido como pressão intraocular entre 6 e 21 mmHg e/ou redução de 30% da pressão intraocular basal com ou sem o uso de medicamentos glaucomatosos. Perda da acuidade visual foi definida como perda de ≥2 linhas de visão na tabela de Snellen ou uma diminuição de ≥ 2 níveis na função visual em pacientes com acuidade do gráfico não mensurável. Resultados: A idade média foi de 61,04 ± 12,99 anos e 11 (52,4%) pacientes eram do sexo masculino, com a maioria (95%) dos pacientes apresentando baixa acuidade visual inicialmente (conta dedos ou pior). A pressão intraocular média foi de 33,38 ± 15,95 mmHg, e o número médio de medicamentos foi de 3,5 ± 1,1, no início do estudo. Após 1, 3, 6 e 12 meses, 76,19%, 57,14%, 55,56% e 66,67%, respectivamente, dos pacientes foram classificados como sucesso do tratamento. Sete (33,3%) pacientes necessitaram de novo tratamento com laser e foram considerados falhas no tratamento. A redução média da pressão intraocular foi de 44,72% ± 29,72% na primeira semana e 41,59% ± 18,93% no final do seguimento (p=0,006). O número médio de medicamentos diminuiu significativamente para 2,00 ± 1,7 na visita de 12 meses (p=0,044). As complicações incluíram hipotonia (4,8%), inflamação intraocular após 1 mês (19%) e perda de acuidade visual (4,8%). Conclusões: A ciclofotocoagulação com laser de diodo transescleral foi segura e eficaz para reduzir a pressão intraocular em olhos com glaucoma refratário e avançado, com necessidade reduzida de hipotensores oculares.

Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope: A modified technique of ciliary body photocoagulation

Purpose: This study aimed to investigate the efficacy of cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope in treating refractory glaucoma. Methods: Eleven patients (11 eyes) with refractory neovascular glaucoma were treated with ciliary body photocoagulation. Preoperative and postoperative corrected visual acuity, intraocular pressure (IOP), ophthalmofundoscopy, B-ultrasound and ultrasound biomicroscopy, optical coherence tomography, and fundus fluorescein angiography were performed. Results: Preoperative IOP ranged from 45 to 58 mmHg (mean 51.9 mmHg). At postoperative 1, 3, and 6 months, the IOPs ranged between 16 and 33 mmHg (mean 27.1 mmHg), 14–28 mmHg (mean 20.6 mmHg), and 14–28 mmHg (mean 18.5 mmHg), respectively. IOP at the last follow-up (range 7–12 months) was 15–24 mmHg (mean 18.8 mmHg). An average of 63.8% decrease in postoperative IOP was found in these patients with no associated complications. The postoperative fibrotic exudate, anterior chamber hyphema, and exudative choroidal detachment were all well-managed and resolved. No patients experienced intraocular lens deviation or dislocation, hypotonia oculi, atrophy of eyeball, retinal detachment, endophthalmitis, or sympathetic ophthalmia. Conclusion: Cyclophotocoagulation with an illuminated laser probe under a noncontact wide-angle retinoscope is a safe and effective technique for the treatment of neovascular glaucoma.

Outcome of Micropulse Laser in Treatment of Open Angle Glaucoma in a Peripheral Hospital in Rivers State, Nigeria: Our Initial Experience

Aims:To determine the Intraocular Pressure (IOP) and visual acuity changes before and after Micropulse laser treatment among patients with open angle glaucoma.Study Design:A quasi-experimental study design.Place and duration of Study:The Ophthalmic Specialists, a peripheral ophthalmologist group practice in Rivers State between February 2018 and December 2018.Methodology:Twelve eligible patients with moderate and advanced open angle glaucoma on medical (topical) treatment were recruited after they gave informed consent. Baseline visual acuity (VA) and intra ocular pressure (IOP) were obtained prior to the use of the micropulse laser treatment. Following the laser treatment, VA and IOP were assessed at oneday, one week, one month and 6 month post laser. p=.05 was regarded as statistically significant.Results:A total of 12 patients were followed up for 6 months. Mean age was 37.42±7.00 years. Age range was 24-46 years with M: F ratio =1.4:1. Mean change in visual acuity across the time periods was statistically significant (p=0.0001). Mean IOP change over 6 months was 10.46mmHg (38.20%, p=0.0001). Median number of drugs used by participants dropped from 3 to 1. (P=0.002)Conclusion:Micropulse Trans-scleral cyclophotocoagulation is a safe and effective way of managing glaucoma. It caused a mean drop in IOP of 10.46mmHg (38.20%) over 6 months in our study

Comparison of efficacy and safety of two different parameters of transscleral cyclophotocoagulation / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To compare the efficacy of transscleral cyclophotocoagulation(TSCP)with two different laser parameters.<p>METHODS: A total of 46 cases with refractory glaucoma(46 eyes)who underwent TSCP from January 2014 to December 2018 were analyzed retrospectively. According to the laser parameters, all cases were divided into low-power group(treated by low-power TSCP)and conventional parameter group(treated by conventional parameter TSCP). Intraocular pressures(IOP), best-corrected visual acuity(BCVA), number of anti-glaucoma drugs and complications were observed and compared between the two groups.<p>RESULTS: There was no significant difference of IOP between the two groups at postoperative 1d, 1wk, 1mo and 3mo(all <i>P</i>>0.05). The total success rate was 87% in the low-power group while 83% in the conventional parameter group(<i>P</i>=1.000).The overall incidence of complications of the low-power group(39%)was lower than that of the conventional parameter group(78%)(<i>P</i>=0.007)at postoperative 3mo. The early postoperative pain score of the low-power group was significantly lower than that of the conventional parameter group(<i>P</i>=0.007).<p>CONCLUSION:Compared with conventional parameters, TSCP with lower power may reduce IOP similarly with less pain and fewer complications.

Lasers in glaucoma

While lasers have been used for many years for the treatment of glaucoma, proper indications and use of the procedures need to be considered before their application. This review summarizes the important laser procedures in Glaucoma.

Observation of transscleral cyclophotocoagulation for glaucoma secondary to vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To evaluate the clinical efficacy and safety of transscleral cyclophotocoagulation(TSCP)for glaucoma secondary to vitrectomy. <p>METHODS: A retrospective review was performed within 20 patients(20 eyes)with glaucoma secondary to vitrectomy underwent TSCP in our hospital from October 2014 to October 2016. The follow-up time was 3mo. The postoperative visual acuity, intraocular pressure(IOP)and complications were observed. <p>RESULTS: One month after operation, the postoperative IOP increased in 9 cases. Another 4 eyes were performed TSCP again, and three of them got the normal IOP recovery. At the last follow-up, visual acuity had no significant changes(<i>P</i>=0.655); IOP was effectively controlled in 14(70%)patients. Meanwhile, the mean postoperative IOP(24.6±11.4mmHg)was statistically reduced than the mean preoperative IOP(42.3±5.9mmHg, <i>P</i><0.05). No serious complications, like hypotony and suprachoroidal hemorrhage, had been observed during 3-month follow-up. <p>CONCLUSION: TSCP procedure is a safe, effective, repeatable surgery for patients with glaucoma secondary to vitrectomy.

Therapeutic effects of ranibizumab combined with trabeculectomy and panretinal photocoagulation for neovascular glaucoma / 眼科新进展

Objective To evaluate the clinical efficacy of intravitreal ranibizumab injection and panretinal photocoagulation for neovascular glaucoma.Methods Totally 8 patients (40 eyes) with neovascular glaucoma in the First Affiliated Hospital of Zhengzhou university from January 2016 to October 2016 were collected in this study,and the patients were randomly divided into two groups according to the different treatments:trabeculectomy group (18 eyes),in which the patients were treated with intravitreal injection of ranibizumab + trabeculectomy + panretinal photocoagulation,and cyclophotocoagulation group (22 eyes),subjects undergoing cyclophotocoagulation + panretinal photocoagulation.All patients were followed up for 6 months.And there was no significant difference in the general data of the two groups (all P ＞ 0.05).Finally,variables including iris neovascularization,the best corrected visual acuity (BCVA),the preoperative and postoperative 1 month,3 months and 6 months intraocular pressure,the operation successful rate and complications in both groups were evaluated and compared.Results In the trabeculectomy group,1 week after treatment,neovascularization in all patients was disappeared,and 6 months of follow-up,a small amount of neovascular recurrence occurred;in the cyclophotocoagulation group,2 weeks after treatment,neovascularization disappeared in 18 eyes,decreased in 3 eyes,and did not change in 1 eye;additionally,6 months of follow-up,some eyes presented neovascularization recurrence.The postoperative BCVA in the trabeculectomy group was significantly higher than that before operation,and the difference was statistically significant (P =0.026),But there was no significant difference between preoperative and postoperative BCVA in the cyclophotocoagulation group (P =0.438).Preoperative BCVA in the trabecuiectomy group was significantly higher than that in the cyclophotocoagulation group,and the difference was statistically significant (P =O.039).The intraocular pressures of the both groups were decreased at 1 month,3 months and 6 months after operation,and the differences were statistically significant (all P ＜ 0.05).There was significant difference in the success rate of operation between the two groups (P =0.047).The efficacy of the trabeculectomy group was better than that of the cyclophotocoagulation group.The incidence of complications in the trabeculectomy group was lower than that in the cyclophotocoagulation group,and the difference was statistically significant (P =O.024).Conclusion It is safe and effective for intravitreal ranibizumab injection + trabeculectomy + panretinal photocoagulation in the treatment of iris neovascularization,of which the clinical efficacy is better than cyclophotocoagulation + pamretinal photocoagulation.

Clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in treatment of traumatic glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

·AIM: To analyze the clinical efficacy and safety of vitrectomy combined with cyclophotocoagulation in the treatment of traumatic glaucoma, and to provide an effective treatment for improving the quality of life of patients with traumatic glaucoma. ·METHODS:Totally 90 patients (90 eyes) with traumatic glaucoma admitted in our hospital from January 2011 to July 2016 were divided into two groups (45 patients in each group) according to different treatment methods. The patients in the observation group underwent vitrectomy combined with cyclophotocoagulation under direct vision; the control group underwent vitrectomy combined with trans-scleral cyclophotocoagulation. We observed the effect of different treatment on visual acuity, intraocular pressure and complication of the two groups. ·RESULTS: The visual acuity of the observation group was significantly better than that of the control group after treatment (Z=-5.689, P<0.05). There was no significant difference on intraocular pressure between the two groups before treatment (P>0. 05). The change of decreased intraocular pressure in the observation group was less than that in the contral group after operation (P<0.05). After 1a follow-up,there was no significant difference on the change of decreased intraocular pressure between the two groups (P>0. 05). The complications of the two groups after treatment were vitreous hemorrhage, choroidal detachment, low intraocular pressure, increased intraocular pressure and other complications, but the complication rate of two groups were no different (x2=1.553,P=0.213).· CONCLUSION: Vitrectomycombinedwith cyclophotocoagulation under direct vision brings patients better visual acuity than that combined with trans-scleral cyclophotocoagulation.

Ciclofotocoagulación transescleral con sonda Nidek vs. G-Probe en el glaucoma absoluto doloroso / Transscleral cyclophotocoagulation with Nidek probe vs. G-Probe in painful absolute glaucoma

Objetivo: comparar los resultados del tratamiento, mediante ciclofotocoagulación transescleral con láser diodo utilizando sonda Nidek y sonda G-Probe, a ojos con glaucoma absoluto doloroso de pacientes atendidos en el Servicio de Glaucoma del Instituto Cubano de Oftalmología Ramón Pando Ferrer durante un año. Métodos: se realizó un estudio comparativo-prospectivo a 50 ojos distribuidos aleatoriamente en dos grupos: 25 ojos sometidos al procedimiento con sonda Nidek y 25 ojos tratados con sonda G-Probe. Se analizaron y compararon las variables presión intraocular, dolor, medicamentos hipotensores utilizados, así como complicaciones posoperatorias antes y después de aplicado el tratamiento. Resultados: los 50 ojos antes del tratamiento eran hipertensos; tres meses después los valores de la presión intraocular eran considerados normales para ambos grupos de estudio. Se mostró una variación estadísticamente significativa (p= 0,0000) respectivamente. Todos los pacientes referían dolor ocular previo. En ambos grupos se redujo satisfactoriamente el componente doloroso y se obtuvieron resultados similares. Se redujo significativamente el número de medicamentos hipotensores, y la mayor parte de los ojos no requirió más terapia farmacológica después de los tres meses. El número de complicaciones asociadas fue discretamente superior en los ojos tratados con sonda Nidek. La uveítis y los picos hipertensivos en el posoperatorio inmediato fue lo más destacado con el uso de ambas sondas. Conclusiones: la ciclofotocoagulación transescleral con láser diodo reduce las cifras de presión intraocular y el componente doloroso con ambas sondas satisfactoriamente. La mayoría de los ojos tratados no requiere terapia farmacológica hipotensora después de 3 meses de realizada. El procedimiento ciclodestructivo es seguro y causa un número discreto de complicaciones con el uso de ambas sondas(AU)

Objective: compare the results of treatment with diode laser transscleral cyclophotocoagulation using Nidek probe and G-probe for eyes with painful absolute glaucoma of patients cared for at the Glaucoma Service of Ramón Pando Ferrer Cuban Institute of Ophthalmology during one year. Methods: a prospective comparative study was conducted of 50 eyes randomly distributed in two groups: 25 treated with Nidek probe and 25 with G-Probe. The following variables were analyzed and compared: intraocular pressure, pain, hypotensive drugs used, and postoperative complications before and after application of the treatment. Results: before treatment, the 50 eyes were hypertensive, whereas three months later intraocular pressure values were considered to be normal in both study groups. A statistically significant variation was found (p= 0.0000). All the patients stated having had ocular pain previously. The two groups showed a satisfactory reduction in pain, with similar results between them. The number of hypotensive drugs was significantly reduced, and most eyes did not require any more drug therapy after three months. The number of associated complications was slightly higher in the eyes treated with Nidek probe. Uveitis and hypertensive peaks in the immediate postoperative period were the most outstanding events with the use of both probes. Conclusions: diode laser transscleral cyclophotocoagulation satisfactorily reduces intraocular pressure values and pain with the use of both probes. Most of the eyes treated do not require hypotensive drug therapy after 3 months. The cyclodestructive procedure is safe, causing a slight number of complications with the use of both probes(AU)

Cyclophotocoagulation through 23G minimally invasive scleral incision treating refractory glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To observe the efficacy and safety of cyclophoto-coagulation through 23G minimally invasive scleral incision in the treatment of refractory glaucoma. <p>METHODS: Totally 23 patients(23 eyes)were taken the surgery-the cyclophotocoagulation-through 23G minimally invasive scleral incision. We observed the changes of intraocular pressure(IOP), the best corrected visual acuity(BCVA), the quantity of drugs reducing intraocular pressure and complications in the pre-and post-operation. <p>RESLUTS: Comparing with preoperative, the postopera-tive IOP, BCVA and the number of IOP-decreased drugs were statistically significant(<i>P</i><0.05); the complication was fewer. <p>CONCLUSION: The 23G minimally invasive scleral incision cyclophotocoagulation is a new type of safe and effective surgical method for the treatment of refractory glaucoma.

Efficacy of two different treatments for secondary glaucoma after traumatic vitrectomy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To compare the clinical efficacy of Ahmed drainage valve implantation and 23G cyclophotocoagulation for secondary glaucoma after traumatic vitrectomy.<p>METHODS: Totally 48 patients(48 eyes)with secondary glaucoma after traumatic vitrectomy were randomly selected from May 2014 to January 2016. According to the principle of random grouping, the patients were divided into experimental group and control group. Experimental group: 25 eyes were implanted with Ahmed drainage valve(25 eyes)and control group: 23G 532nm laser ciliary body photocoagulation(23 eyes). The intraocular pressure(IOP)and related complications were compared between the two groups. <p>RESULTS: The intraocular pressure control rate was 83%(19/23)in the experimental group and 72%(18/25)in the control group, the difference was no statistically significant(<i>χ</i>²=0.76, <i>P</i>=0.19). The postoperative complication rate was 39%(9/23)of experimental group at 1wk after operation. The overall complication rate in the control group was 68%(17/25), which was significantly higher than that in the experimental group(<i>χ</i>²=4.02,<i>P</i>=0.03). At postoperative 3mo, corneal endothelial cell density of two groups decreased, compared with the preoperative, the difference was statistically significant(<i>t</i>=4.22, <i>P</i><0.05), that of experimental group decreased by 13%, control group by 21%, with no statistical difference(<i>P</i>>0.05).<p>CONCLUSION: Ahmed drainage valve implantation and 23G cyclophotocoagulation are safe for the treatment of secondary glaucoma after traumatic vitrectomy. The operation is relatively safe, but 23G cyclophotocoagulation is more effective, for economic and practical, fewer complications.

The clinical effect of endoscopic cyclophotocoagulation in the treatment of refractory glaucoma in contrast with glaucoma drainage device implant / 实用医学杂志

Objective To evaluate the efficacy of ECP and glaucoma drainage device implant in the management of refractory glaucoma. Methods A retrospective study was explored in refractory glaucoma in 99 eyes,in which there were 50 eyes in the ECP group(group A)and 49 eyes in the group of glaucoma drainage device implant (group B). The changes of intraocular pressure (IOP),visual acuity and complication were observed. Results (1)IOP:There was statistically significant difference in IOP between the preoperative and last follow-up in each group(T-Test,t = 2.47,t = 2.51,P 0.05).(3)Complication:The early complications of the group A included anterior chamber exudation ,short-term high IOP,hyphema. In the group B,the early complications included shallow anterior chamber,hyphema, drainage valve block and high IOP,MSCH,choroidal detachment,while the medium-term complication was glaucoma valve fiber wrapped high IOP and the long-term complications included glaucoma drainage tube rejection , exposure and displacement,and endophthalmitis,conjunctival hyperplasia. Conclusion ECP and glaucoma drainage implant can be effective in the treatment of refractory glaucoma. The ECP has less complications.

Diode laser transscleral cyclophotocoagulation as a primary surgical treatment for glaucoma-questions and future / 中华实验眼科杂志

Cyclophotocoagulation is one of the efficacious procedures for the treatment of refractory glaucoma.However,its clinical utilization is limited due to severe post-operative complications including phthisis and visual loss.Transscleral cyclophotocoagulation (TCP) is technically simple and less affected by the opening status of the anterior chamber angle.Its effectiveness and complications are mainly related to the energy,spots and scale of the surgery,as well as the ocular pigmentation of the patients.With the advance of technology,both the effectiveness and safety of this procedure gain significant improvement.Meanwhile,it is free from the filtration surgery-related complications due to its noninvasive characteristics.Taken the local economic level,medical resources allocation,as well as the patients' preference and follow-up into account,utilization of TCP on primary open angle glaucoma (POAG) patients with good vision,or as primary surgical treatment for medically uncontrolled chronic angle closure glaucoma (CACG) and neovascular glaucoma (NVG) were recently tried and showed good preliminary results.It provides new insight in glaucoma therapy,although further evidence from prospective,random control trials are still needed.In present review,both the safety and efficiency,as well as related influent factors of TCP were summarized.The possibility and feasibility of this procedure as a primary surgical treatment for glaucoma were discussed.

Therapeutic effects of combination therapy for neovascular glaucoma / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To investigate therapeutic effects of combination therapy for neovascular glaucoma ( NVG) . METHODS: This retrospective study comprised 34 eyes of 34 patients who suffered from NVG. All patients were assigned to group A, B, C and D according to the different combination therapies. Group A ( 11 eyes of 11 patients ) was treated with intravitreal injection of ranibizumab and panretinal photocoagulation ( PRP ) . Group B ( 10 eyes of 10 patients ) was treated with transcleral cyclophotocoagulation and PRP. Group C ( 6 eyes of 6 patients) was treated with 3 therapies together. Group D (7 eyes of 7 patients) was treated with 810nm transcleral cyclophotocoagulation and soft gas-permeable contact lenses. All the patients were followed-up for 1a. The best- corrected visual acuity ( BCVA ) , intraocular pressure ( IOP ) were recorded and analyzed prior to operation and 1, 4wk, 6 and 12mo after operation. RESULTS: All the post treatment IOP decreased significantly ( P 0. 05 ) in statistics. Most patients' IOP can be controlled below 23mmHg after combination therapy. The visual acuity in group A after 1, 4wk, 6mo compared with those before treatment was significantly increased ( P0. 05). Anterior chamber bleeding occurred to 2 cases after 1wk of transcleral cyclophotocoagulation. No other ocular or systemic adverse events were found during the follow-up duration. CONCLUSION: After the combination of intraocular injection of the anti - VEGF drugs, 810nm laser cyclophotocoagulation and PRP, most patients with NVG disease can be effectively treated, can effectively control IOP, and retain part of the visual function, significantly improve the quality of life. In the short - term, combination therapy is safe and effective for NVG, which provides us an available strategy to conquer NVG by simply programmable operation and less suffering.