Neurotrophic Keratopathy After Slow Coagulation Transscleral Cyclophotocoagulation

Abstract

Purpose: Decreased corneal sensation and subsequent neurotrophic keratopathy (NK) is an uncommon complication after transscleral cyclophotocoagulation (TSCPC). Post-TSCPC NK has been rarely reported in the literature, predominantly after traditional, “pop technique” continuous-wave TSCPC or micropulse CPC. The authors report the first case series of NK after slow-coagulation TSCPC (SC-TSCPC). Methods: This was a respective chart review of patients who developed NK after SC-TSCPC. The collected data included demographic data, type of glaucoma, risk factors for corneal anesthesia in addition to the number of laser spots, and the extent of the treated area. Results: Four eyes experienced NK after SC-TSCPC. The median time for the development of NK was 4 weeks. At the final visit, 2 patients had a resolution of NK, 1 had a persistent corneal ulcer, and 1 had worsening NK and corneal perforation. Conclusions: NK is a rare but a vision-threatening complication that can develop after SC-TSCPC in patients with risk factors for decreased corneal sensation. Early diagnosis and proper management are crucial to reducing the risk of vision loss and improving the prognosis of these cases.

Continuous Wave Transscleral Cyclophotocoagulation and Endoscopic Cyclophotocoagulation in Childhood Glaucoma: A Meta-Analysis

“…This stems from the procedure's relatively low success rate and higher incidence of complications including vision loss, phthisis, uveitis, retinal detachment, microbial keratitis, chronic inflammation, and sympathetic ophthalmia. 14,19,25,36,37 The later use of CPC in pediatric glaucoma may also suggest that it is used with less healthy eyes that are more prone to complications. In our analysis, we found complications in 19% (60/324 eyes) in the TS-CPC group and 10% (26/249 eyes) in the ECP group.…”

Topical insulin in neurotrophic keratopathy after diabetic vitrectomy

“…In diabetic keratopathy, several corneal changes have been reported, including abnormal basement membrane structure, poor epithelial adherence, hypothesia, and alterations in the corneal stroma, Descemet membrane, and corneal endothelium 7 . Also, NK has been reported as a rare complication of pan-retinal photocoagulation (PRP) and trans-scleral cyclophotocoagulation 8 – 12 . The primary suggested mechanism entails thermal injury to the long ciliary nerve branches as they enter the suprachoroidal space at the positions corresponding to 3 and 9 o'clock on the retina 10 , 13 .…”