Laser Management of Glaucoma in Exfoliation Syndrome

Sandhu, Simrenjeet; Damji, Karim F.

doi:10.1097/ijg.0000000000000909

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…In a recent review article by Sandhu & Damji (), TCP was proposed as a reasonable option for treatment of refractory PEX glaucoma. It has been suggested that excessive exfoliation material on the zonules can hinder laser uptake in endoscopic cyclophotocoagulation (Francis et al.…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of transscleral cyclophotocoagulation in Swedish glaucoma patients

Rasmuson

Lindén

Lundberg

et al. 2019

Acta Ophthalmologica

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Purpose: To retrospectively evaluate the efficacy and safety of all transscleral cyclophotocoagulation (TCP) treatments performed during a 5-year period. Methods: Medical records of all patients, who had undergone TCP treatment between 2010 and 2014 at Ume a University Hospital, Sweden, were evaluated. Clinical data including intraocular pressure (IOP), visual acuity (VA), number of topical glaucoma medications, use of oral acetazolamide, retreatments and complications during a 2-year follow-up were registered. Global success was defined as IOP 6-18 mmHg with or without glaucoma medication. Results: Three hundred patients underwent TCP during the time period. Mean IOP at baseline was 29.3 AE 11.0 (mean AE standard deviation) mmHg (n = 297) with a mean reduction of 11.5 (AE12.0) mmHg at 1 year (n = 258; p < 0.001) and 12.6 (AE12.0) mmHg at 2-year follow-up (n = 245; p < 0.001). Global success at 2 years was 64%, achieved by a mean of 1.2 treatments (n = 257). The number of topical glaucoma medications at baseline was 3.1 (AE1.0; n = 296) and was reduced by 0.9 (AE1.0) medications at 2 years (n = 244; p < 0.001). Use of oral acetazolamide decreased from 30% (n = 90) at baseline to 5.3% (n = 13) at 2 years. In eyes with Snellen VA ≥ 0.1, the mean VA at baseline was 0.55 (AE0.3) logarithm of the minimum angle of resolution (logMAR; n = 132) and 1.1 (AE0.9) logMAR (n = 76) at 2 years (p < 0.001). No cases of phthisis bulbi were found. Conclusion: This study displays a substantial and long-term reduction of IOP following TCP with a decrease in topical and oral glaucoma medications. The treatment appears to be safe but the decrease in VA during follow-up is a concern that needs further evaluation.

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Section: Discussionmentioning

confidence: 99%

Efficacy and safety of transscleral cyclophotocoagulation in Swedish glaucoma patients

Rasmuson

Lindén

Lundberg

et al. 2019

Acta Ophthalmologica

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“…During the years of the recruitment period, COCO procedures accounted for approximately 5% of all glaucoma surgeries in our study center. Overall—in contrast to classic tCPC literature [ 24 , 41 ]—PEX seems to negatively influence efficacy in terms of IOP–SSI after COCO in the same way as PEX may hinder laser uptake in endoscopic CPC [ 42 ]. The finding that PEX is a risk factor for more IOP-SSIs can be explained by the fact that PEX causes chronic progressive congestion of the outflow pathways of the eye by protein material.…”

Section: Discussionmentioning

confidence: 99%

Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation

Lenzhofer

Hohensinn

Hitzl

et al. 2021

Graefes Arch Clin Exp Ophthalmol

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Purpose Transscleral controlled cyclophotocoagulation (COCO) is a transscleral 810-nm diode laser cyclophotocoagulation that automatically adjusts the applied laser energy utilizing an optical feedback loop. The present study investigates the influence of pseudoexfoliation (PEX) on the efficacy of COCO in a Caucasian study population. Methods Retrospective data from 130 consecutive eyes were analyzed during a 2-year follow-up. Baseline characteristics, intraocular pressure (IOP), number of IOP-lowering medications, visual field, best-corrected visual acuity (BCVA), and secondary surgical interventions (SSI) were analyzed. The primary endpoint was IOP reduction at M24 compared to baseline, and the secondary endpoints were IOP course, reduction of IOP-lowering medications, surgical success, and IOP-lowering SSIs stratified by PEX and baseline IOP. Results IOP reductions of −35, −39, −25, −25, −23, −34, and −36% could be achieved from baseline to D1, W1, M1, M3, M6, M12, and M24 (all p < 0.001), respectively, while there was a significant overall reduction over time (p < 0.001) in the number of topical IOP-lowering medications postoperatively. The proportion of eyes requiring additional systemic IOP-lowering medication reduced from 31 to 0% at M24 (p = 0.025). Eyes without PEX and IOP < 30 mmHg at baseline had the lowest risk for IOP-lowering SSIs (p < 0.03). BCVA dropped at M12 (0.25 [95% CI: 0.12–0.38]), and the drop persisted during the following 12 months. Conclusion The present study demonstrates a midterm IOP-lowering effect after COCO while reducing the burden for topical and systemic IOP-lowering medications. Patients without PEX and IOP < 30 mmHg have a lower risk of SSI. The procedure per se cannot be excluded as causative for the decreased postoperative BCVA. Further prospective investigations are suggested.

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Sekundäre Offenwinkelglaukome: Pseudoexfoliationsglaukom, Pigmentglaukom und Neovaskularisationsglaukom

2022

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Laser Management of Glaucoma in Exfoliation Syndrome

Cited by 5 publications

References 29 publications

Efficacy and safety of transscleral cyclophotocoagulation in Swedish glaucoma patients

Efficacy and safety of transscleral cyclophotocoagulation in Swedish glaucoma patients

Two-year efficacy after first transscleral controlled cyclophotocoagulation in patients with and without pseudoexfoliation

Sekundäre Offenwinkelglaukome: Pseudoexfoliationsglaukom, Pigmentglaukom und Neovaskularisationsglaukom

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