The use of endoscopic cyclophotocoagulation for moderate to advanced glaucoma

Six year outcomes of combined phacoemulsification surgery and endoscopic cyclophotocoagulation in refractory glaucoma

PURPOSE

This study is to describe the 6-year results of combined phacoemulsification surgery and endoscopic cyclophotocoagulation (Phaco-ECP) surgery in patients with uncontrolled glaucoma and no previous glaucoma surgery.

METHODS

This is a retrospective case series of 84 eyes. The primary outcome measure was intraocular pressure (IOP) reduction 6 years postoperatively. Secondary outcome measures were the cumulative probability of failure of the surgical procedure at 6 years. Failure was defined as IOP higher than 21 mm Hg or lower than 6 mm Hg or IOP not reduced by 20% from baseline at the 1, 2, 3, 4, 5, or 6-year time points or further laser or other surgery to reduce IOP at any timepoint.

RESULTS

There was a statistically significant decrease in mean IOP from 18.9 mmHg pre-operatively to 13.7, 12.8, 13.0, 12.7, 12.5, and 12.3 mmHg at the 1, 2, 3, 4, 5, and 6 years post-operatively respectively (p < 0.001). Fifty-seven (68%) reached criteria for failure by 6 years. In 36% of cases, this was due to inadequate IOP control, whereas 32% required further laser or surgery. When we excluded patients who only had selective laser trabeculoplasty rather than further surgery, the failure rate reduced to 51%. Eleven percent had a post-operative complication, 2.4% requiring further surgical intervention.

CONCLUSIONS

At 6 years postoperatively, combined phaco-ECP achieved a significant reduction in IOP in patients with uncontrolled glaucoma and no previous drainage surgery. Significant complications were uncommon, but 68% was classified as surgical failures by the six year point.

Does prior endoscopic cyclophotocoagulation (ECP) affect subsequent trabeculectomy outcomes?

Purpose

To report long-term outcomes of trabeculectomy following prior endoscopic cyclophotocoagulation (ECP).

Methods

Retrospective case-controlled comparative study reporting 2-year outcomes of eyes undergoing trabeculectomy following failed prior ECP (group 1), using eyes undergoing trabeculectomy as a primary glaucoma procedure as controls (group 2).

Results

Filtration surgery was required in only 19.4% (12/62) of eyes undergoing ECP. Of these, nine eyes that underwent trabeculectomies were included in group 1. Nine matched eyes were used as controls and included in group 2. Mean baseline IOPs were 23.7 ± 7.7 and 26.0 ± 6.7 mmHg (p = 0.452) in groups 1 and 2, respectively, on a mean of 3.4 ± 0.9 and 2.8 ± 1.4 medications, respectively (p = 0.274). The mean 2-year IOP was 10.6 ± 5.2 and 12.9 ± 4.0 mmHg (p = 0.285) in groups 1 and 2, respectively, on a mean of 0.1 ± 0.3 and 0.1 ± 0.4 medications (p = 0.931) respectively. Complete success rates were 77.8% and 88.9% in groups 1 and 2, respectively (p = 0.527). Qualified success rates were 11.1% in both groups. Combined success rates were 88.9% and 100.0% in groups 1 and 2, respectively (p = 0.318). There were no failures in group 2, compared to 11.1% in group 1 (p = 0.318). There were no significant between-group differences in hypotony, bleb needling, cystoid macular oedema, persistent uveitis, or repeat filtration surgery rates.

Conclusions

ECP is a safe initial procedure in eyes with progressive glaucomas, and may substantially reduce the need for trabeculectomy without compromising outcomes in the minority that go on to require it.

Safety and Efficacy of Isolated Endoscopic Cyclophotocoagulation in Pseudophakic Patients with Primary Open-Angle Glaucoma-12-Month Follow-Up

Background: We evaluated the safety and efficacy of endoscopic cyclophotocoagulation (ECP) for eyes with primary open-angle glaucoma (POAG). Methods: We included a total of 104 pseudophakic eyes treated with ECP. Visual acuity and intraocular pressure (IOP, mmHg) measurements were evaluated preoperatively and on days 1 and 7 and 2 and 12 months postoperatively. IOP ≤ 15 or ≥30% reduction from baseline were defined as therapeutic success. Results: The mean baseline IOP was 23.89 ± 8.63, and it decreased significantly at the day 1 (16.25 ± 7.32, p < 0.0001), day 7 (17.81 ± 6.37, p < 0.0001), 2nd month (17.77 ± 8.54, p < 0.0001) and 12th month (16.42 ± 7.05, p < 0.0001) follow-up visits. Therapeutic success was achieved in 55 (61.80%) eyes at the 12-month follow-up. Patients with POAG duration longer than 10 years or those using alpha agonist eye drops had a lower rate of therapeutic success (odds ratio: 0.52, 95% CI = 0.32–0.85, p < 0.05 and odds ratio: 0.92, 95% CI = 0.55–0.95, p = 0.024, respectively). A longer disease course was associated with higher IOP values (Rs =+0.281; p = 0.024) postoperatively. The number of antiglaucoma medications decreased significantly from 2.55 ± 1.16 to 2.11 ± 1.14 (p = 0.003). The ECP complications included a minor IOP increase (9.37%), pupil irregularity (15.73%), and the presence of fibrin (3.29%). Conclusions: The ECP is an effective and safe option, especially in eyes with a shorter glaucoma course.

Long-term Surgical Outcomes of Phacoemulsification with Endoscopic Cyclophotocoagulation vs Phacoemulsification with Trabeculectomy and Mitomycin in Cataract and Glaucoma Patients

Purpose

To evaluate the long-term surgical outcomes of endoscopic cyclophotocoagulation (ECP) after four years follow-up in cataract and glaucoma patients that needed combined phacoemulsification and ECP (phaco-ECP) in comparison to combined phacoemulsification with trabeculectomy (phaco-trabeculectomy) with mitomycin C (MMC).

Patients and Methods

Retrospective case–control study of 34 patients (34 eyes) with glaucoma who underwent phaco-ECP compared with phaco-trabeculectomy in tertiary eye specialist hospital in Saudi Arabia from 2010 to 2012. Participants were enrolled in two groups; ECP and trabeculectomy with MMC when combined with phacoemulsification. Success is defined as complete success when the IOP ≤21 mmHg without medication, qualified success when the IOP ≤21 mmHg with aid of topical medication.

Results

Mean IOP decreased from 25.76 SD ±8.227 to 15.24 SD ±7.049 at last visit in phaco-trabeculectomy group and from 21.47 SD ±4.215 to 12.88 SD ±3.480 in phaco-ECP group. Mean medication use reduced from 2.89 SD ±0.3 preoperatively to 1.50 SD ±1.1 postoperatively (P<0.001) in phaco-trabeculectomy group. It reduced in phaco-ECP group from 2.24 SD ±0.8 preoperatively to 2.00 SD ±0.9 postoperatively, 35.3% of phaco-trabeculectomy group developed vision-threatening complications while 0% in phaco-ECP group (P<0.001), 29.4% in phaco-trabeculectomy group required second surgical intervention compared to 17.6% in phaco-ECP group. In phaco-trabeculectomy group, 29.4% reached complete success, meanwhile in phaco-ECP group, 64.7% reached qualified success (P=0.026).

Conclusion

ECP illustrates significant reduction of IOP and less postoperative complications if associated with phacoemulsification. Furthermore, it is safe and effective as a primary procedure alternative to combined cataract and trabeculectomy surgery for glaucoma patients having cataract and requiring surgical intervention.

An update on continuous-wave cyclophotocoagulation (CW-CPC) and micropulse transscleral laser treatment (MP-TLT) for adult and paediatric refractory glaucoma

PURPOSE

Continuous-wave cyclophotocoagulation (CW-CPC) is often preferred to medical and surgical treatments for managing refractory glaucoma. This review summarizes diode CW-CPC indications, history, histopathology, methods, efficacy and safety. It also provides an overview of the latest data available on micropulse transscleral laser treatment (MP-TLT) that uses repetitive micropulses of diode laser energy in an off-and-on cyclical fashion.

METHODS

A literature review was conducted on transscleral CW-CPC (CW-TSCPC), endoscopic CPC (ECP) and MP-TLT. Relevant series of adult and paediatric patients were included for assessing the procedures.

RESULTS

Regarding CW-TCPC, highly variable success rates are reported in the literature, depending on the definition of success, type of underlying glaucoma, energy settings, follow-up duration and retreatment rates. CW-CPC often needs to be repeated, especially in paediatric patients. CW-CPC exposes to risks of inflammation and chronic ocular hypotony or phthisis with irreversible visual loss. CW-TSCPC has mainly been used in very severe forms of glaucoma, in painful eyes with limited visual potential or after filtering surgery failure. Published data on ECP are more limited but overall good success rates have been reported. Through the direct visualization of the targeted ciliary body in anatomically abnormal eyes, ECP is the preferred surgical procedure in paediatric refractory glaucoma. Complication rates are relatively low after ECP; however, large studies with long-term follow-up are needed. ECP may be used in difficult, refractory cases, but it is often used earlier when combined with cataract surgery. Despite limited data on the exact mechanism of action of MP-TLT and a lack of standardization of laser settings, the first data from heterogeneous case series shows that it has a similar efficacy and a better safety profile compared to CW-TSCPC in the medium term.

CONCLUSION

Although they may lead to sight-threatening complications, both CW-TSCPC and ECP seem effective. ECP appears to be superior to CW-TSCPC in paediatric refractory glaucoma. Unlike ECP combined with cataract surgery, evidence supporting a wider use of CW-TSCPC and MP-TLT in earlier stages of neuropathy is lacking. While it now appears that the safety profile of MP-TLT is superior to that of CW-CPC, robust prospective comparative studies including homogeneous and well-defined cohorts of patients are still needed to confirm an at least comparable efficacy in the long term.

Efficacy and Safety of Combined Surgeries including Intraocular Direct Cyclophotocoagulation with a 532 nm Laser to Treat Advanced Neovascular Glaucoma

Purpose

The purpose of this study was to assess the efficacy and safety of intraocular direct cyclophotocoagulation (IDCP) using a 532 nm laser with combination treatment in reducing intraocular pressure (IOP) for patients with advanced neovascular glaucoma (NVG) with angle closure. In addition, we sought to determine the success rate and frequency of complications and explore an optimized solution to reduce the number of topical medications and the pain of patients.

Methods

A retrospective case note review of all patients undergoing combined treatment including IVR, phaco, PPV, PRP, and IDCP from January 2017 to June 2018.

Results

In total, 24 consecutive patients (25 eyes) were reviewed. The mean IOP was significantly decreased from 42.2 ± 8.5 mmHg preoperatively to 15.56 ± 2.0 mmHg (P < 0.0001), and no neovascularization of the iris (NVI) reoccurred at month 18. The number of medications used was reduced from 2.72 ± 0.45 preoperatively to 0.87 ± 0.40 at month 18 (P < 0.0001).

Conclusions

During 18 months of follow-up, the combined treatments were safe and had a significant IOP-lowering effect. This study provides a new method of performing IDCP with a 532 nm laser, allowing for the use of internal cyclophotocoagulation without extra equipment.

Phacoemulsification Combined With Endoscopic Versus Transscleral Cyclophotocoagulation in Poorly Controlled Glaucoma: A Comparative Case Series

OBJECTIVE

The objective of this study was to report medium-term outcomes of a novel combination of phacoemulsification with transscleral cyclophotocoagulation (phaco-TCP) compared with combined phacoemulsification and endoscopic cyclophotocoagulation (phaco-ECP) in patients with uncontrolled or suboptimally controlled glaucoma and coexisting cataract.

MATERIALS AND METHODS

Retrospective case series of 80 consecutive patients with a minimum of 12 months of follow-up. In total, 46 eyes underwent phaco-ECP and 34 phaco-TCP. Success was defined as intraocular pressure (IOP) between 6 and 21 mm Hg with ≥20% reduction from preoperative IOP (with no increase in ocular hypotensive medications or further glaucoma surgery). Secondary outcomes were change in IOP, number of ocular hypotensive medications and safety.

RESULTS

The mean follow-up was 32.6 ±10.3 months. Preoperative clinical characteristics were similar in both groups. At latest follow-up, success rate was greater with phaco-TCP than phaco-ECP (67.6% and 47.8%, P=0.037). IOP was also significantly lower after phaco-TCP (14.88±5.57 mm Hg, from 22.62±6.52 mm Hg) than phaco-ECP (18.07±6.72 mm Hg, from 22.83±7.88, P=0.0273). Ocular hypotensive medications required reduced similarly after phaco-TCP (from 3.38±0.88 to 2.65±1.04 medications, P=0.0012) and phaco-ECP (from 3.07±0.929 to 2.63±1.42 medications, P=0.0108). There were no cases of hypotony or reduction in vision related to glaucoma with either surgical intervention and a similar proportion required further glaucoma surgery (phaco-ECP 15.2%, phako-TCP 5.9%, P=0.2884).

CONCLUSIONS

Phaco-TCP appears more successful in controlling IOP than phaco-ECP with similar safety. Further investigation is warranted of this newly proposed combination which may be particularly useful where access or experience with ECP or other minimally invasive glaucoma surgery is limited.

Study of minimally invasive radiofrequency ablation of the ciliary body for the treatment of glaucoma in rabbits

The aim of the present study was to explore the safety and effectiveness of radiofrequency ablation (RFA) of the ciliary body for the treatment of glaucoma. A glaucoma model was established in New Zealand white rabbits, which were then treated with RFA of the ciliary body, utilizing an XL-1-type RF meter developed by the Chinese PLA General Hospital. After treatment, general ocular investigation, including ocular pressure was carried out, the anterior chamber was imaged via ultrasound biomicroscopy, and the pathological changes were observed via hematoxylin and eosin (H&E) staining. It was determined that the glaucoma model was successfully established in the New Zealand white rabbit by inducing high intraocular pressure (IOP). After RFA treatment, ablation spots were observed but no clear anterior chamber reaction was found. The ablation group showed a steady and continuous decrease of IOP, which was significantly lower than the model group at days 3 and 7 (P<0.05). A sclera pathway was observed in the ablation site 1-day post-treatment, which had mostly recovered by day 7. H&E staining demonstrated shedding of the ciliary epithelium, and an unclear boundary between muscle layer and blood vessel at day 1. This had fully recovered by day 14, with clear ciliary layers and well-arranged muscle structures observed. The present study suggested that treatment with RFA could decrease IOP without substantial side effects in the glaucoma model in the rabbit. Therefore, it could be used as a strategy to control IOP and as a treatment for glaucoma in the clinic.

A case series of endoscopic cyclophotocoagulation with 532-nm laser in Japanese patients with refractory glaucoma

PURPOSE

To report an initial case series of Japanese patients with refractory glaucoma treated with endoscopic cyclophotocoagulation (ECP) using an ECP device that was equipped with a 532-nm neodymium-doped yttrium aluminium garnet (Nd:YAG) laser.

METHODS

This observational case series included 10 consecutive glaucomatous eyes (7 with primary open-angle glaucoma; 3 with secondary glaucoma after cataract surgery) of 10 Japanese subjects (7 men, 3 women; mean age ± standard deviation, 65.7 ± 15.0 years) who underwent ECP to control intraocular pressure (IOP), and preserve visual function. Age, sex, glaucoma type, ocular surgical history, preoperative and postoperative logarithm of the minimum angle of resolution visual acuity (VA), IOP, number of antiglaucoma medications, perioperative complications, and treatments for complications were collected from the medical and surgical records. The IOP and numbers of antiglaucoma medications were compared between preoperative and postoperative values.

RESULTS

The mean preoperative IOP (27.3 ± 5.4 mm Hg; range, 19-36) and number of antiglaucoma medications (4.4 ± 0.8; range, 3-6) decreased significantly by 53% and 39% ( p = 0.0005 and p = 0.0043, respectively) to 12.9 ± 5.2 mm Hg (range, 8-20) and 2.7 ± 1.4 (range, 0-4), respectively, at the final visit. Compared with preoperative values, a mixed-effect regression model showed significant decreases in the IOP and numbers of medications at every time point up to 24 months postoperatively. No phthisis bulbi or persistent hypotony was recorded. At the final visit, compared with preoperative values, the VA decreased in three eyes by >0.2 unit because of glaucoma progression.

CONCLUSIONS

ECP with Nd:YAG laser is a reasonable option in eyes with refractory glaucoma.

Combined Phacoendoscopic Cyclophotocoagulation versus Combined Phacotrabeculectomy in the Management of Coexisting Cataract and Glaucoma: A Comparative Study

Purpose

To compare the surgical outcome of combined phacoemulsification and endoscopic cyclophotocoagulation (phacoECP) versus combined phacoemulsification and mitomycin C-augmented trabeculectomy (phacoTbx) in patients with coexisting glaucoma and visually significant cataract.

Methods

A retrospective review of 89 eyes of 89 patients who received phacoECP (N=49) and phacoTbx (N=40) was carried out at a tertiary eye center in Hong Kong. The minimum follow-up period was 6 months. Criterion of success was reduction of IOP at least 30% or absolute IOP of 15 mmHg or below without (complete success) or with (qualified success) antiglaucomatous medication.

Results

PhacoTbx had more reduction of antiglaucomatous medication (4 vs 1, P < 0.001). At postoperative year one, there was more IOP reduction for phacoTbx than phacoECP (8 mmHg vs 3 mmHg, P=0.012). The one-year complete success rate was also higher for phacoTbx (46.2% vs 8.2%, P < 0.001), while qualified success was comparable between the 2 groups (74.4% vs 73.5%, P=0.925). Operation time was shorter for phacoECP (37 vs 73 minutes, P < 0.001). The number of postoperative follow-up visits was less (6 vs 11.5, P < 0.001) for phacoECP. Additional surgical procedures were more common in phacoTbx (55% vs 0%, P < 0.001). There was no postoperative cystoid macula edema, hypotony, or endophthalmitis reported in both groups.

Conclusions

PhacoECP is significantly less effective than phacoTbx in reduction of both IOP and number of antiglaucomatous medications for patients with medically uncontrolled glaucoma and cataract. Its complete success rate is also significantly lower than that of phacoTbx. With its comparable qualified success, shorter operation time, less number of postoperative visits, and secondary surgical intervention, phacoECP may still have a role in very selected cases.

Development of a biodegradable antifibrotic local drug delivery system for glaucoma microstents

To prevent implant failure due to fibrosis is a major objective in glaucoma research. The present study investigated the antifibrotic effects of paclitaxel (PTX), caffeic acid phenethyl ester (CAPE), and pirfenidone (PFD) coated microstent test specimens in a rat model. Test specimens based on a biodegradable blend of poly(4-hydroxybutyrate) biopolymer and atactic poly(3-hydroxybutyrate) (at.P(3HB)) were manufactured, equipped with local drug delivery (LDD) coatings, and implanted in the subcutaneous white fat depot. Postoperatively, test specimens were explanted and analyzed for residual drug content. Fat depots including the test specimens were histologically analyzed. In vitro drug release studies revealed an initial burst for LDD devices. In vivo, slow drug release of PTX was found, whereas it already completed 1 week postoperatively for CAPE and PFD LDD devices. Histological examinations revealed a massive cell infiltration in the periphery of the test specimens. Compact fibrotic capsules around the LDD devices were detectable at 4–36 weeks and least pronounced around PFD-coated specimens. Capsules stained positive for extracellular matrix (ECM) components. The presented model offers possibilities to investigate release kinetics and the antifibrotic potential of drugs in vivo as well as the identification of more effective agents for a novel generation of drug-eluting glaucoma microstents.

Argon laser-assisted hypotony model in the rabbit

To investigate whether ocular hypotony formation with 360 degrees endocyclophotocoagulation is possible. Twelve male New Zealand White rabbits were used. Entire ciliary body epithelium was destructed with green laser photocoagulation after pars plana lensectomy and anterior vitrectomy in six rabbits. Endocyclophotocoagulation was not performed to the remaining six rabbits (control group). Intraocular pressure (IOP) was measured preoperatively and followed up everyday in the first week and weekly until the end of month one. All of the rabbits were sacrificed and ciliary bodies were left for gross and light microscopic examination. Mean baseline IOPs were similar in laser and non-laser group (14.8 ± 1.4 (range 12.2-17.3) vs 14.4 ± 1.4 (range 12.2-15.9), p = 0.650). Mean IOP was 6.6 ± 0.45 mmHg (range 5.9-7.1) in the laser group and 11.5 ± 1.2 mmHg (range 10.2-13.4) in the non-laser group in postoperative day 1. IOP was below 4 mmHg in all eyes on the second day and after in laser group. In the macroscopic evaluation, the entire ciliary body had a white (loss of pigmentation) and atrophic appearance in all of the eyes in the laser-treated group compared to non-laser group. In the laser group, light microscopic examination demonstrated a severe 360 degrees disruption of ciliary processes. Ciliary processes were covered with fibrin exudation consisting of fibroblasts. There was a mild inflammation with disruption or atrophy of ciliary body epithelium with cystic vacuolar degeneration. Three hundred sixty degrees endocyclophotocoagulation yielded severe ciliary epithelium damage. IOP reduction started very early and continued in hypotonic levels during follow up period.

Endoscopy-assisted vitrectomy in the anterior vitreous

Endoscopy-assisted ocular surgery is a relatively old technique that is increasingly being recognized for its application in cases of vitreoretinal disease. This technique is especially useful when both the vitreous and retina are difficult to access because of media opacity, a small pupil, or a microcornea. In this context, the anterior vitreous is often difficult to dissect because of its complex pathological changes. This article reviews the common anatomical features and pathologies that are observed in the anterior vitreous, as well as the applications and indications of endoscopy-assisted vitrectomy in the anterior vitreous.

High-Intensity Focused Ultrasound Circular Cyclocoagulation in Glaucoma: A Step Forward for Cyclodestruction?

The ciliary body ablation is still considered as a last resort treatment to reduce the intraocular pressure (IOP) in uncontrolled glaucoma. Several ablation techniques have been proposed over the years, all presenting a high rate of complications, nonselectivity for the target organ, and unpredictable dose-effect relationship. These drawbacks limited the application of cyclodestructive procedures almost exclusively to refractory glaucoma. High-intensity focused ultrasound (HIFU), proposed in the early 1980s and later abandoned because of the complexity and side effects of the procedure, was recently reconsidered in a new approach to destroy the ciliary body. Ultrasound circular cyclocoagulation (UC³), by using miniaturized transducers embedded in a dedicated circular-shaped device, permits to selectively treat the ciliary body in a one-step, computer-assisted, and non-operator-dependent procedure. UC³ shows a high level of safety along with a predictable and sustained IOP reduction in patients with refractory glaucoma. Because of this, the indication of UC³ was recently extended also to naïve-to-surgery patients, thus reconsidering the role and timing of ciliary body ablation in the surgical management of glaucoma. This article provides a review of the most used cycloablative techniques with particular attention to UC³, summarizing the current knowledge about this procedure and future possible developments.

Multicenter clinical trial of high-intensity focused ultrasound treatment in glaucoma patients without previous filtering surgery

PURPOSE

To evaluate the efficacy and safety of the ultrasonic circular cyclocoagulation procedure in patients with open-angle glaucoma naïve of previous filtering surgery.

METHODS

Prospective non-comparative interventional clinical study conducted in five French University Hospitals. Thirty eyes of 30 patients with open-angle glaucoma, intra-ocular pressure (IOP) > 21 mmHg and with no previous filtering glaucoma surgeries were sonicated with a probe comprising six piezoelectric transducers. The six transducers were activated with a 6-s exposure time. Complete ophthalmic examinations were performed before the procedure and at 1 day, 1 week, 1, 2, 3, 6 and 12 months after the procedure. Primary outcomes were qualified surgical success (defined as IOP reduction from baseline ≥20% and IOP > 5 mmHg with possible re-intervention and without hypotensive medication adjunction) and complete surgical success (defined as IOP reduction from baseline ≥20%, IOP > 5 mmHg and IOP < 21 mmHg with possible re-intervention and without hypotensive medication adjunction) at the last follow-up visit and vision-threatening complications. Secondary outcomes were mean IOP at each follow-up visit compared with baseline, medication use, complications and re-interventions.

RESULTS

Intra-ocular pressure was significantly reduced (p < 0.05) from a mean pre-operative value of 28.2 ± 7.2 mmHg (n = 3.6 hypotensive medications) to 19.6 ± 7.9 mmHg at 12 months (n = 3.1 hypotensive medications and n = 1.1 procedures) (mean IOP reduction of 30%). Qualified success was achieved in 63% of eyes (19/30) (mean IOP reduction of 37% in these eyes) and complete success in 46.7% of eyes (14/30) (mean IOP reduction of 37% in these eyes) at the last follow-up. No major intra- or post-operative complications occurred.

CONCLUSIONS

The UC(3) procedure seems to be an effective and well-tolerated method to reduce IOP in patients with open-angle glaucoma without previous filtering surgery.

Transpupillary Argon Laser Cyclophotocoagulation in a Refractory Traumatic Glaucoma Patient with Aphakia and Aniridia

We present a case of transpupillary argon laser cyclophotocoagulation (TALC) in a patient with traumatic aniridia and aphakia secondary to blunt trauma who had previous bilateral trabeculectomy. Four months after the trauma the patient's intraocular pressure (IOP) rose to 35 mmHg despite topical antiglaucomatous medication. Inferior 180 degrees cyclophotocoagulation was performed with transpupillary argon laser in the first session and his IOP fell to values of 12-17 mmHg. Twelve weeks after TALC, his IOP rose to 22 mmHg and we had to apply TALC to the residual ciliary processes. Seven months later his IOP was 13 mmHg with topical dorzolamide/timolol and latanoprost administration. TALC may be an effective treatment alternative for lowering IOP in patients with visible ciliary processes who do not respond to conventional medical or laser treatment.