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.

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.

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.

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)

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.

The Long-term Result of Diode Laser Transscleral Cyclophotocoagulation in the Management of Refractory Glaucoma after Intravitreal Silicone Oil Injection for Complicated Retinal Detachment

PURPOSE: To evaluate the long-term results of contact transscleral cyclophotocoagulation (TSCPC) in eyes with secondary glaucoma following intravitreal silicone oil injection. METHODS: Medical records of 18 eyes of 17 patients who underwent TSCPC following intravitreal silicone oil injection for complicated retinal detachment were reviewed. TSCPC was performed using diode laser at a power of 1.5 to 2.5 W, duration of 2 seconds, and with 14 to 27 applications. Intraocular pressure (IOP), number of glaucoma medications, status of anterior segment and retina, complications and visual acuity were evaluated. RESULTS: Overall mean number of treatments given per eye was 1.6. After a mean follow-up period of 122.7 (range, 49 to 228) weeks, the mean pretreatment IOP, 42.1+/-13.5 mmHg, decreased to 19.5+/-12.3 mmHg (p=0.001). The number of glaucoma medications was significantly decreased from 2.8+/-0.9 to 0.9+/-1.12 (p= 0.000). Hypotony or phthisis bulbi developed in one eye, respectively. Excluding the six eyes with no light perception before treatment, 4 (33.3%) of 12 eyes had stable or improved visual acuity at the final follow-up visit. Five of 8 eyes showing visual deterioration lost light perception. CONCLUSIONS: Medically uncontrolled glaucoma secondary to intravitreal silicone oil injection can be treated with TSCPC, although there is a significant risk of visual loss associated with the procedure.

Diode laser transscleral cyclophotocoagulation for refractory glaucoma / 眼科新进展

Objective　To evaluate the clinical efficiency of diode laser transscleral cyclophotocoagulation(TSCPC) for the treatment of refractory glaucoma.Methods　TSCPC were performed in 23 eyes of 23 patients with medically and surgically uncontrolled glaucoma. The laser was operated with a power of 2～3W,duration of 1.5～2s and laser spots(18) were evenly placed 270 around the limbus except temporal. Followed for 3～24 months (average:11 months) . Results　The mean intraocular pressure before and after treatment in 23 eyes were 6.10kPa±2.34kPa and 2.55kPa±1.22kPa respectively,which was statistically significant (P<0.01). IOP below 2.80kPa was obtained in 20 eyes (86.9%). At the time of last visit,the post-operative visual acuity was partly improved besides NLP.Conclusion　Diode laser transscleral cyclophotocoagulation is effective in treating refractory glaucoma. Its advantages are low ratio of ocular hypotension,no atrophy of eyeball,no pain, acceptability,reoperation and therapeuty in clinic and so on.

The Effect of Contact Transscleral Nd:YAG Laser C yclophotocoagulation in Refractory Glaucoma

We observed the change of intraocular pressure(IOP)and the complications after contact transscleral cyclophotocoagulation with Neodymium:YAG (Nd:YAG)laser for the refractory glaucoma patients. Refractory glaucoma in twenty eyes was treated with contact transscleral continuous-wave Nd:YAG laser cyclophotocoagulation with a sapphire-tipped probe. Using 7W of power for 0.7 seconds with 32 applications and intraocular pressure(IOP) was measured at 1 day, 1 week, 1 month, 2 months, 3 months, 4 months, 5 months and 6 months, postoperatively. The intraocular pressure(IOP)decreasing rate was 62% and the success rate was 60%at 6 months postoperatively. It is suggested that contact transscleral cyclophotocoagulation with Nd:YAG laser is useful in lowering IOP in refractory glaucoma patients.

Long-term Results of Diode Laser Trans-scleral Cyclophotocoagulation in Neovascular Glaucoma

To determine the long-term efficacy of diode laser trans-scleral cyclophotocoagulation in neovascular glaucoma, a retrospective analysis was done in 30 patients(32 eyes) with intractable neovascular glaucoma treated with diode laser trans-scleral cyclophotocoagulation between March 1996 and June 1997, by reviewing the treatment parameters, complications, and preand postoperative intraocular perssure(IOP). The IOP was compared using a Wilcoxon signed rank test, and the success rate was evaluated by a Kaplan-Meier life-table analysis. Success was defined as an IOP of 21mmHg or lower in the absence of phthisis without any additional surgical procedure. The mean follow-up was 54.6+/-13.3 weeks. The mean preoperative IOP was 46.2+/-9.6mmHg. The mean postoperative IOP was 10.5+/-8.7mmHg(p=0.000). The mean number of preoperative medications was 2.2+/-0.6. The mean number of postoperative medications was 0.5+/-0.9(p=0.000). Kaplan-Meier survival analysis showed a probability of continued success at 44 weeks and 60 weeks to be 80.2% and 44.5%, each, without any antiglaucoma medications and 86.4% and 66.1%, each, with some antiglaucoma medications. Complications included phthisis(12.5%), hypotony(9.0%), and hyphema(25%). This study suggests that diode laser trans-scleral cyclophotocoagualtion provides a significant long-term reduction of intraocular pressure in eyes with intractable neovascular glaucoma.

An Effects of Contact Transscleral Diode Laser Cyclophotocoagulation in Refractory Glaucoma Patients

We evaluated the the effect and the suitable level of ciliary ablation with diode laser contact transscleral cyclophotocoagulation[TSCPC] in eyes with refractory glaucoma. Fourteen eyes were treated with contact transscleral cyclophotocoagulation on 180 degree[Group 1, 6 eyes], and 270 degree[Group 2, 8 eyes], and the intraocular pressure was measured at 1 day, 1 week, 1 month, 3 month, postoperatively. The mean preoperative intraocular pressure was 46.8+/-14.3 mmHg and the mean intraocular pressure at last examination was 29.5+/-13.2 mmHg. Success rate was defined as follows:[1] more than 20% intraocular pressure reduction from baseline, [2] less than 21 mmHg at final examination. Based on the definition of success 1, the success rate was 66.6% in group 1 and 87.5% in group 2. Based on the definition of success 2, the success rate was 50% in both group. It suggests that contact transscleral cyclophotocoagulation with diode laser is useful in lowering IOP in refractory glaucoma patients and the treatment is also effective with ablation of 180 degree area in refractory glaucoma patients.

A Comparison of Cyclocryotherapy and Contact Transscleeral Cyclophotocoagulation with Diode Laser in Rabbit

Cyclodestruction is generally achieved by applying thermal energy across the intact sclera. Commonly employed modalities are ultrasound, cryopexy, diathermy, noncontact laser light and most recently, contact transscleral laser using argon, krypton and Nd:YAG, diode laser. This study was performed to compare the pressure lowering and tissue effects of contact transscleral cyclophotocoagulation(TSCPC) with diode laser using G prode to cyclocryotherapy in rabbit. The results of this study demonstrate a similar intraocular pressure lowering effect of both cyclocryotherapy and contact TSCPC with diode laser using G prode. Histologic studies showed that both TSCPC and cyclocryotherapy are effective anatomic cyclodetructive modalities but in case of TSCPC, less severe destruction of ciliary body was noted. This study indicated that contact TSCPC with diode laser using G probe delivery provieds effective and safe management for eyes with medically and surgically uncontrolled glaucoma compared to cyclocryotheraphy.

Changes in IOP and HIstopathology Following Contact Transscleral Cyclophotocoagulation with Diode Laser in High Tension Rabbit Eyes

We evaluated the acute and long term intraocular pressure(IOP) lowering effect of diode laser contact transscleral cyclophotocoagulation by applying G probe to argon laser induced high tension pigmented rabbits through the changes in IOP and histopathology. Eighteen eyes of 18 high tension pigmented rabbits were treated with diode laser contact transscleral cyclophotocoagulation (24-30 application) 0.5mm posterior to the limbus over 360degrees and the other eyes were used as controls. The rabbits were divided into 3 groups according to the energy levels of diode laser (1st group; 0.8J of energy, 2nd; 1.0J of energy, and 3rd; 1.2J of energy). There were mean decrease in IOP of 24.4%, 38.4%, and 38.7% in 1st, 2nd, and 3rd groups respectively during 5 weeks after tratment (p<0.05). After treatment, microendoscopic findings of the ciliary body revealed blenching in 1.0 and 1.2J groups. Light microscopy 1 day after treatment revealed coagulation necrosis of the pigmented and nonpigmented ciliary epithelium, congestion of vessels, thrombosis, and pigment dispersion in all energy groups, with destruction increasing in relation to power. Five weeks after treatment, atrophy and fibrosis of the ciliary nonpigmented and pigmented epithelium and stroma were observed in all groups.