Long-term efficacy and visual acuity following transscleral diode laser photocoagulation in cases of refractory and non-refractory glaucoma

Abstract

Aims Transscleral diode laser cyclophotocoagulation (TSCP) is widely accepted in the treatment of refractory glaucoma especially in eyes with poor vision. However, until recently, there has been a reluctance to extend its use to eyes with good visual acuity (VA). The aims of this study were to evaluate the long-term efficacy and safety of TSCP for a range of glaucoma conditions, with particular emphasis on post-treatment VA in seeing eyes. Methods A retrospective analysis of case notes of 74 treated eyes was conducted over a period of 4-30 months (mean 12.5 months). Results Mean (SD) intraocular pressure (IOP) was reduced by 43% from 40.3 (6.7) to 21.1 mmHg (5.4) at the final index visit. Of all patients, 58% had a reduction in glaucoma drops and all discontinued oral Acetazolamide; 9% experienced complications. Mean VA was preserved in the subgroups with good vision, although 3/23 (13%) patients with primary open-angle glaucoma (POAG) lost vision due to cataract and glaucoma progression. There were no cases of hypotony (IOPp5 mmHg) or phthisis and only one eye required re-treatment. Conclusions TSCP is highly effective and safe for various types of glaucoma, and its use can be extended to eyes with good vision.

Endoscopic and Transscleral Cyclophotocoagulation for the Treatment of Refractory Glaucoma

“…[34][35][36][37][38][39] This may be related to the lower energy settings and the relatively higher proportion of primary open-angle glaucoma and less severe forms of glaucoma than in prior studies.…”

“…38 Egbert et al 34 used diode TCP soon after the institution of antihypertensive drops in recently diagnosed cases of glaucoma in Ghana. Because of the relative poor access to healthcare and medical treatment, TCP was evaluated as a plausible and relatively noninvasive alternative.…”

“…The development of the compact, portable diode laser for ophthalmic use has made it more convenient to perform contact TCP. [26][27][28][29][30][31][32][33][34][35][36][37][38][39] The semiconductor diode laser (IRIS Oculight SLx, Iris Medical Inc, Mountain View, CA) emits at 810-nm wavelength and is better absorbed by melanin than the Nd:YAG, although scleral transmission is reduced at this wavelength. [23][24][25] The flat tip of the handpiece (known as the ''G-Probe'') protrudes 0.7 mm deeper than the contact surface, indenting the conjunctiva and sclera to allow better laser penetration.…”

“…[22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] Using the Nd:YAG laser [Surgical Laser Technologies (SLT) Inc, Malvern, PA], a handheld sapphire-tipped probe is placed on the conjunctiva and sclera, centered 1 to 2 mm behind the limbus for the transmission of laser energy. The development of the compact, portable diode laser for ophthalmic use has made it more convenient to perform contact TCP.…”

Lower energy levels adequate for effective transcleral diode laser cyclophotocoagulation in Asian eyes with refractory glaucoma

“…The number of topical drugs required for IOP control also reduced significantly in all subgroups of patients. Other studies have also demonstrated 100% freedom from oral acetazolamide following DLCP, 15,30 whereas in the study by Spencer and Vernon 24 (who used a lower energy treatment protocol), 91% of patients were free from oral acetazolamide.…”