A new approach for CW-TSCPC to improve its safety and efficacy in glaucoma treatment

PURPOSE

The goal of our study was to compare the outcomes of transscleral diode cyclophotocoagulation using a new protocol with new settings. In fact, we targeted the ciliary body guided by transillumination, reduced the energy applied at each spot, and enlarged the treatment area posteriorly from the pars plicata to the pars plana.

PATIENTS AND METHODS

Data were collected retrospectively from two groups of glaucoma patients. The first group of patients underwent transscleral diode laser cyclophotocoagulation as usual, with one-row applications of a maximum of 1200mW of energy and a duration of 2000ms. The second group was treated in three rows, using the same settings as the first group. Transillumination was used continuously during all of our procedures, to focus accurately on the location of the ciliary body. Outcome measures included intraocular pressure (IOP) and visual acuity (VA) at baseline and at a minimum of 3 months postoperatively, as well as complications occurring up until last follow-up visit. Patients were considered successfully treated if their intraocular pressure was lowered by at least 25% compared to their baseline or if their intraocular pressure was less than 21mmHg after the procedure, with or without glaucoma medications.

RESULTS

Sixty eyes were treated with the one-row protocol, followed by 508 eyes treated with the three-row protocol. The mean follow-up was 19 (range 3-31) months. Success rates were 62% and 86% for the one-row group and three-row group, respectively. The IOP decrease was 40.5% (a mean reduction from 37.5±8.1mmHg to 22.3±10.2mmHg) in the one-row group and 57.6% in the three-row group (mean reduction from 36.05±10.4mmHg to 15.7±7.3mmHg), which was statistically significant in each group (P=0.0001). Additionally, a significant improvement in efficacy was found in the 3-row compared to the 1-row group (P=0.0001) No significant difference was found in VA before or after the procedure or between the 2 groups. No serious complications were reported.

CONCLUSIONS

Diode laser TSCPC is a practical, rapid and well-tolerated procedure. The treatment protocol used, with lower energy levels applied to the eye, guided systematically by transillumination and targeting a wider area, appears to be safer and more effective.

[Micropulsed diode laser transscleral cyclophotocoagulation: An effective technique whose role remains to be defined]

Micropulse Transscleral Cyclophotocoagulation (MP-TSCP) is a recently developed cyclodestructive procedure less aggressive than conventional TSCP. In this study, we aimed to evaluate the safety and efficacy of MP-TSCP in a real-life setting.

MATERIAL AND METHODS

We retrospectively included all MP-TSCP cases performed in the Bicêtre Hospital Ophthalmology department between January 2017 and September 2019. Intraocular pressure (IOP) and hypotensive medications were recorded preoperatively, at month 1, 3, 6 and at the conclusion of follow-up, as well as postoperative adverse events. Success was defined as an IOP between 6 and 21mmHg with a decrease of at least one medication or an IOP reduction>20%.

RESULTS

Thirty eyes (28 patients) were included. Preoperative IOP was 27.2±10.6mmHg, with 3.5±0.6 hypotensive medications, the mean deviation on the Humphrey 24-2 visual field was -21.9±6.9dB, and 43% of eyes had a past history of filtering surgery. The mean follow-up was 13.5±8.1 months. Eleven patients (37%) had to be retreated with MP-TSCP during follow-up. At 3 and 6 months and at the conclusion of follow-up, the IOP was 18.3±7.3mmHg (-33%; P<0.0001), 22.5±11.8mmHg, (-17%; P=0.052), 22.7±12.0mmHg (-16,5%; P<0.050), respectively. The success rates were 57%, 50% et 53% at 3 months, 6 months and at the conclusion of follow-up, respectively. Severe adverse events included 3 cases of corneal ulcers and 2 cases of severe but transient ocular hypotony without visual impairment.

CONCLUSION

MP-TSCP is an effective procedure for severe and/or refractory glaucoma, but retreatments are required in more than one-third of cases. Further studies are warranted to define factors predictive of success and indications for retreatment.

Ahmed glaucoma valve in various etiologies of refractory glaucoma: Surgical outcomes and success factors

PURPOSE

To study the epidemiology and mid-term results of the Ahmed glaucoma valve (AGV) in various etiologies of refractory glaucoma in a Lebanese center, and to assess complications and factors that influence the surgical success rate.

METHODS

In this retrospective epidemiological study, we reviewed 108 eyes with refractory glaucoma that underwent an AGV implantation in a tertiary care center in Lebanon between January 2002 and August 2014. Findings including best-corrected visual acuity (BCVA), intra-ocular pressure (IOP), number of antiglaucoma medications, factors influencing the surgical outcome, success rate and complications were also reviewed.

RESULTS

The mean duration of follow-up was 29.85±21.45 months [range, 3-60 months]. As in other Arab countries and compared to the rest of the world, the rate of neovascular glaucoma (NVG) was particularly high, occurring in 63 eyes (58.3%), and represented the primary cause of refractory glaucoma. Mean IOP was significantly reduced to 17.97±7.35mmHg at the last follow-up visit (P<0.05). Similarly, a significant decrease was noted in the number of antiglaucoma medications (P<0.05). The surgical success rate, defined as a postoperative IOP<21, was significantly higher (62.0%), in older patients, those with baseline BCVA≤2 LogMAR and those with a history of hypertension (P<0.01). Hyphema was the most noted complication.

CONCLUSION

The AGV is a safe and effective procedure for lowering IOP in refractory glaucoma patients, with hyphema being the most frequent complication. Both the presence of hyperstension and initial BCVA≤2 LogMAR seem to increase the success rate of the procedure. NVG remains the most common etiology for implantation, probably due to uncontrolled diabetes in the Middle East and North Africa.