Diode Laser Transscleral Cyclophotocoagulation for the Treatment of Refractory Glaucoma After Penetrating Keratoplasty

Ocakoğlu, Özcan; Arslan, Osman; Kayıran, Alp

doi:10.1080/02713680590968529

Cited by 38 publications

(25 citation statements)

References 19 publications

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“…The probability of graft survival was 79% at one year and 56% at five years [215]. Ocakoglu et al reported 97% of eyes with an IOP \22 mmHg at six months and 72% of eyes at twelve months with or without medications in patients undergoing CPC for refractory post-PKP glaucoma [216]. Another study reported IOPs of 6 to 21 mmHg were achieved in 79% of patients undergoing CPC for refractory post-PKP glaucoma with the need for re-treatment in 57% with a minimum of six months follow-up [217].…”

Section: Cyclodestructive Proceduresmentioning

confidence: 96%

Graft failure: III. Glaucoma escalation after penetrating keratoplasty

Greenlee

Kwon

2008

Int Ophthalmol

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Glaucoma after penetrating keratoplasty is a frequently observed post-operative complication and is a risk factor for graft failure. Penetrating keratoplasty performed for aphakic and pseudophakic bullous keratopathy and inflammatory conditions are more likely to cause postoperative glaucoma compared with keratoconus and Fuchs' endothelial dystrophy. The intraocular pressure elevation may occur immediately after surgery or in the early to late postoperative period. Early postoperative causes of glaucoma include pre-existing glaucoma, retained viscoelastic, hyphema, inflammation, pupillary block, aqueous misdirection, or suprachoroidal hemorrhage. Late causes include pre-existing glaucoma, angle-closure glaucoma, ghost cell glaucoma, suprachoroidal hemorrhage, and steroid-induced glaucoma. Determining the cause of IOP elevation can help guide therapeutic intervention. Treatments for refractory glaucoma include topical anti-glaucoma medications such as beta-adrenergic blockers. Topical carbonic anhydrase inhibitors, miotic agents, adrenergic agonists, and prostaglandin analogs should be used with caution in the post-keratoplasty patient, because of the possibility of corneal decompensation, cystoid macular edema, or persistent inflammation. Various glaucoma surgical treatments have reported success in post-keratoplasty glaucoma. Trabeculectomy with mitomycin C can be successful in controlling IOP without the corneal toxicity noted with 5-fluorouracil. Glaucoma drainage devices have successfully controlled intraocular pressure in postkeratoplasty glaucoma; this is, however, associated with increased risk of graft failure. Placement of the tube through the pars plana may improve graft success compared with implantation within the anterior chamber. In addition, cyclophotocoagulation remains a useful procedure for eyes that have refractory glaucoma despite multiple surgical interventions.

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Section: Cyclodestructive Proceduresmentioning

confidence: 96%

Graft failure: III. Glaucoma escalation after penetrating keratoplasty

Greenlee

Kwon

2008

Int Ophthalmol

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“…[39][40][41][42][43][44] However, multiple treatments may be necessary and graft failure rates have been reported to be between 17 and 44%. [39][40][41][42][43][44] With 5-year follow-up, Beiran reported successful IOP reduction in patients with post-keratoplasty glaucoma using transscleral Nd:YAG laser in 63% of the patients. Fifty-six percent of these patients had clear grafts after 5 years.…”

Section: Cyclodestructive Proceduresmentioning

confidence: 99%

“…40 More recent studies on the use of diode laser to control post-keratoplasty glaucoma show a single treatment success rate of 72% after 12 months with no cases of graft failure or phthisis bulbi. 43 In a small series, Ayyala reported no differences between trabeculectomy with mitomycin C, cyclophotocoagulation, and glaucoma shunt procedures to control glaucoma after keratoplasty. 39 …”

Section: Cyclodestructive Proceduresmentioning

confidence: 99%

Management of patients with combined glaucoma and corneal transplant surgery

Banitt

Lee

2009

Eye

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Penetrating keratoplasty (PKP) is associated with an increased risk of secondary glaucoma. The development of glaucoma after PKP is an important risk factor for decreased corneal graft survival. The incidence of glaucoma after corneal transplant as well as the mechanism of developing increased intraocular pressure is reviewed in this paper. Treatments for post-PKP glaucoma include medications, laser, and surgery. The most frequent surgical glaucoma intervention is implantation of a glaucomadrainage device. Recent advances in corneal transplantation surgery may help to decrease corneal failure and the risk of developing post-keratoplasty glaucoma.

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“…Because it is a destructive procedure, trans-scleral cyclophotocoagulation has traditionally been used to permanently reduce high intraocular pressures in non-seeing eyes with poor prognosis or to relieve refractory glaucoma when other more conservative measures have failed. Serious side effects can occur with traditional TS-CPC like hypotony, vision loss, iritis, and rarely sympathetic ophthalmia and pthisis bulbi [2].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Micropulsed Transcleral Cyclophotocoagulation in Moderate to Severe Glaucoma

Toyos¹,

Rol²,

Toyos³

2016

J Clin Exp Ophthalmol

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Purpose: The purpose of this study is to evaluate the safety and effectiveness of a new micropulsed transcleral continuous wave diode laser in a clinical setting of patients diagnosed with open angle glaucoma, ranging from mild glaucoma to severe. Methods:Twenty-six eyes of thirteen patients were treated by a single surgeon at a single private practice center. Results were reviewed retrospectively. Each subject was treated with preset MP3 setting according to recommended treatment guidelines. Results:At baseline, patients were on an average of 3.3 topical glaucoma medications with an average IOP of 25.6 mmHg. At POD1 IOP was reduced by 20%, by 34% at POD7, 8% at POD28 and decreased 30% from baseline at the final postop visit 6-12 months after the procedure. Average medication use decreased from 3.3 to 1.8 from baseline to final post op visit. There were no serious adverse events. Conclusion:Micropulsed transcleral diode laser is a safe and effective alternative for glaucoma therapy for patients with open angle glaucoma. Patients can expect significant IOP lowering along with reduction in number of topical glaucoma medications required for IOP control.

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Diode Laser Transscleral Cyclophotocoagulation for the Treatment of Refractory Glaucoma After Penetrating Keratoplasty

Abstract: Diode laser TSCPC appears to be a safe and effective procedure for the treatment of uncontrolled glaucoma secondary to penetrating keratoplasty.

Cited by 38 publications

References 19 publications

Graft failure: III. Glaucoma escalation after penetrating keratoplasty

Graft failure: III. Glaucoma escalation after penetrating keratoplasty

Management of patients with combined glaucoma and corneal transplant surgery

Clinical Outcomes of Micropulsed Transcleral Cyclophotocoagulation in Moderate to Severe Glaucoma

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